18 yr old female with pancytopenia

 24 February, 2022

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Khushi Tulsyan

Roll no. 75


A 18 yr old female patient presented to opd for blood transfusion. 


HISTORY OF PRESENTING ILLNESS-

Patient was apparently asymptomatic 40 days back.She had her 1st dose of vaccination (covishield/covaxin not known) then she developed mild fever pain at the site of injection and was doing well until 20 days back where she had her periods (regularly irregular - once in two months ) she was lethargic it is known to be having it everytime since she gets her periods there was no change in her fever and pain and she had dyspnea on exertion and was shown to local doctor where her blood levels were checked and found to be low ( not known by attender) and a tonic (zincovite) was given to her. She showed no signs of improvement and started having shortness of breath grade 4 and was shown to the some other hospital 2 days back. There she was give some tonic(ferric oxide) for increasing her blood she was found to be low and blood transfusion was advised. She presented to our hospital for blood transfusion.

No known recent infection/trauma/medication.

PAST HISTORY-


Not a known case of htn/dm/ aasthma/leprosy/epilepsy.


MENSTRUAl HISTORY-


Menarche - 16 yrs

Has an cycle of once every 2-3 months

2-3 pads/day lasting for 5 days. 


PERSONAL HISTORY-


Diet - Vegeterian- (had vomiting when young on ingestion of chicken - so doesn't consume) 

Appetite- decreased since vaccination

Bladder and bowel - regular

Addictions - none

Allergy - not known

Decreased weight according to age - 22kgs.


FAMILY HISTORY-

No known family history. 

Has 2 younger siblings ( sisters) who are thin according to age according to the mother. 

But they have non veg.


GENERAL EXAMINATION-


Patient is examined under well lit room and adequate ventilation with his consent taken

Patient is conscious , coherent and cooperative well orientated to time, space and person. He is moderately built and  nourished. 

Pallor is present.

No icterus, edema, lymphadenopathy, clubbing, Cyanosis. 

VITALS-

Temp - afebrile

BP - 110/70

Pulse - 110 bpm

Resp rate - 15 cpm

Sp O2 - 97 %


SYSTEMIC EXAMINATION-

CVS -

S1, S2 heard

On palpation :

Parasternal heeves heard

Apex beat heard

Raised jvp


ABDOMEN-

Scaphoid shape 

No tenderness

No palpable masses

Bowel sounds present

CNS-

No focal neurological defecits. 

RESPIRATORY SYSTEM-

No dyspnea

NVBS

PROVISIONAL DIAGNOSIS-
?B12 deficiency
INVESTIGATIONS-

USG - 
No significant finding

2D ECHO-
No diastolic dysfunction
Good lv systolic function

ECG-

HAEMOGRAM-
SEROLOGY-
Negative 
It is also negative for dengue, malaria




PLAN OF CARE-

Inj optineuron in ns
Pantaprazole
Blood transfusion
Ceftriaxone
Inj monocet

FOLLOW UP-

25-2-22:
After 2 units of blood transfusion


DISCUSSION-














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