Plasmodium Vivax with Anemia with Jaundice under evaluation

A 35 year old female presented to OPD with compalints of high grade fever with bleeding per rectum while passing stools, headache, unable to walk and pain abdomen Chief Complaints Generalised Body ache, fever high grade, bleeding from rectum while passing stools, headache, unable to walk, pain abdomen No complaint of loose stools History Patient had been under treatment of probably a quack for past one week, after which her condition got deteriorated and she started bleeding per rectum Vitals She is afebrile at the time of examination, BP 100/70 Pulse 130 Spo2 96% Physical Examination Conjunctival pallor and icterus is present Investigations Her reports are attached Diagnosis Plasmodium Vivax with Anemia with Jaundice under evaluation Management 1) Injection Artesunate 120mg stat, after 12 hours, and continue 12 hourly until 5 doses completed ( I will start her Lariago DS later as she is having pain abdomen which will be further aggravated) (Primaquine cant be given as Hb is low) 2) Injection pantop 40 24 hourly 3) Inj Ethamsylate 1amp 12 hourly 4) Tab Cefixime + Ofloxacin 200/200 BD 5) Tab Limcee 500mg BD, 6) Tab Caripill TDS 7) Tab Udiliv 150mg BD Advised for urgent transfusion for one unit prbc and one unit FFP Kindly give your valuable opinion on whether something needs to be added or some advise

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Hemolytic jaundice Indirect is more than direct Bleeding p/a is also bcz hemolysis exclude hemorrhoides Yes pt will response to artisunate but also lariago can be used intramuscularly Iv dextrose to be continued Monitor vitals Correct anaemia with replacement

Thanx dr Kute Ankush
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When you are going better with detail line of management, what do you expect from the forum. If it's acknowledgement....We do acknowledge your line of treatment and logic !!

Thanks for the acknowledgement sir. I really appreciate your opinion. You are a support pillar for every young curofian like me. And yes you asked about what I expect from forum is that, if someone can add something valuable to it that can enhance the line of treatment. As you have already appreciated, I am blessed.
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I will recommend whole blood infusion,3 pints Whole blood will deliver RBC,platelet and clotting factors

Good presentation of case , treatment continue and add blood transfusion to correct anemia

Thanks Dr. Sanchay Ghoshal ,Dr. Kute Ankush , Dr. Ramesh Kumar Singh
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Sir you are on right way . Go ahead sir

Your treatment is good

Admit cause of malena cause of jaundice g6pd if non affording then ref to municipal hospital any iv for malaria for gp is medicolegal so careful

@montaz 1gm injection is also need pt... Because tlc r increase cefexim +ofloxacin not mutch

If patient is not affording transfer patient to govt hospital .