Concluded Case

Pancytopenia under evaluation

A 24 yr male presented with C/O shorntness of breath with palpitation , H/O fever on and off since 1.5 month, H/O malena 15days back , H/O alcohol intake since october 2019 to march 2020 aprox 500ml twice a week O/E - severe pallor P/A - hepatospleenomegaly P/R - fresh blood present CBC Hb -2.8 tlc -3800 p/c 64k retic count 2% ldh 2048 something vit b12 -83 INR raised 1.93 (normal range 0.8 to 1.5) periph blood smear - Moderate anisopoikilocytosis,predominent microcytic to normocytic ,hypochromia present , NO fregmented cell seen platelets reduce but normal morphology viral markera negative sgot /pt 35/14 ser bil total 2.9 indir 1.50 direct 1.40 stool occult blood negative urine RM - albumin trace and 6 to 8 pus cell UGIE AND COLONOSCOPY both normal kindly suggest for further evaluation (if we keep BMA and BM Biopsy as last resort)

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Concluded answer

its severe megaloblastic anemia with abd kochs

All Answers

As UGIE and colonoscopy are normal and if we keep BMA and BM biopsy as last resort. , keeping in mind severe anaemia , hepatosplenomegaly ,with malena and PR fresh blood present D/D is 1 Myelodysplastic syndrome 2.Bleeding haemorrhoids 3.Meckels diverticulum will heterotropic gastric epithelium and bleeding ulcer . 4.AML 5.Haemolytic anaemia 6.Intestinal tuberculosis 7.Pernicious anaemia. 8Cirrhosis lover Get a CECT abdomen before getting finally BMA and BM biopsy

Thank you sir..will add CECT report in comments
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@Hardik Ahuja kindly give your opinion

its severe megaloblastic anemia with abd kochs

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