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)


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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