Major case presentation Dimorphic anemia - PowerPoint Presentation

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Major case presentationDimorphic anemia

SCENARIO:

Here is a 35years old female patient admitted in medicine female

ward diagnosed as dimorphic anemia was hospitalized for 6 days.

CHIEF COMPLAINTS:

c/o breathlessness since 15 days

c/o giddiness since 15 days

HISTORY OF PRESENT ILLNESS: Patient was apparently alright

15 days back then she developed breathlessness, insidious in onset

a

nd progressive. Patient also complains of giddiness even at rest

g

radually progressive.

PAST MEDICAL HISTORY:

Patient is a k/c/o anemia blood transfusion was done when she delivered

second child

LABORATORY INVESTIGATION:

Peripheral smear report:

Dimorphic anemia with leucopoenia with mild thrombocytopenia

Test

Patient value

Normal value

WBC

4500 cumm

4000-11000 cumm

RBC

1.12

million/

μ

l

4.0-5.5

million/

μ

l

Hb

4.5 g/dl

11-14g/dl

PCV

12.3 %

35-46%

MCV

109.8 fl

80-100fl

MCHC

36.6 g/dl

32-36 g/dl

MCH

40.2 g/dl

32-36 g/dl

ESR

70 mm/hr

<20 mm/hr

MPV

13.0

fl

7.4-11.4

fl

PDW

15.7 fl

10-14 fl

Platelet count

1.50

1-3

lakhcell

/cumm

General physical examination:

Pallor +

SOAP NOTE:Subjective:Here is a 35 years old female presenting complaints of breathlessnessand giddiness since 15 days.Objective:RBC is decreased that indicates anemia.Hb is drastically decreased which indicates severe anemiaESR is increased due to infectionPCV is decreased that indicates over hydration or due to anemia or blood loss.

MCV & MCH values are increased which indicates

macrocytic

&

hyperchromia.RDW (RBC distribution width)the normal values are found in anemia.MPV (mean platelet vol ) is increased it indicates there is destruction of platelets. (Alloimmune thrombocytopenia - eg, neonatal, post-transfusion)PDW (platelet distribution width) is increased it indicates high PDW means that platelet size varies greatly, a sign of active platelet release.Peripheral smear shows that dimorphic anemia with

leucopeonia

with mild thrombocytopenia.

Diagnosis:by

observing the above subjective and objective data the patient is diagnosed with dimorphic anemia.

ASSESSMENT:

Problem list:

1.Breathlessness

2.Giddiness3.Dimorphic anemia-Breathlessness:It is due to anemia the oxygen carrying capacity is decreased.-Giddiness:It is due to anemiaDimorphic anemia : is a dual population of RBCs in the peripheral blood smear with both microcytic

hypochromic

and

normocytic

macrocytic

red blood cells which is a typical finding of iron

deficiency vitamin B12/folic acid deficiency anemia.

PLAN OF CARE:

Goals of therapy:

To alleviate signs and symptoms

Correcting the underlying etiology Prevent reoccurence of anemia.

S.no

Brand name

Generic name

Dose & freuencyDay1234561.IVF dextrose500mlYY

Y

Y

Y

Y

2.

O2

inhalation

Y

Y

3.

Inj.Bactocef

iv

Cefuroxime

1gm

1-0-1

Y

Y

Y

Y

Y

Y

4.

Inj.Pantox

iv

Pantoprazole

40mg

1-0-0

Y

Y

Y

Y

Y

Y

5.

Inj.P-cet

iv

Ondansetron

1amp

1-1-1

Y

Y

Y

Y

Y

Y

6.

Syp.Hemowin

Oral iron supplement

2tsp

0-0-1

Y

Y

Y

Y

Y

Y

7.

Inj.Vitcofol

im

Folic acid

2cc

0-1-0

Y

Y

Y

Y

8.

Cap.Fesovit

FA+

nico+B6+B12 + Feso4

0-1-0

Y

Drug-drug interactions:

Cefuroxime +

pantoprazole

- decreases the absorption of cefuroxime Monitor CBC for the normal levels RBC,Hb Patient counselling:Patient is advised to take iron rich diet such as green leafy vegetables, fruits, egg, liver, kidney etc,Discharge drugs:

1.syp.Hemowin 2tsp -0-0-1 x 10 days

2. cap.

Fesovit

0-1-0 x 30 days

3. Inj.

Vitcofol

2cc

im

0-1-0 alternate days for 1 wk.

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