hemolytic anemia

1. WARD CASE PRESENTATION
Dr. Maaz Seerat
PGR-1
West Medical Ward

2. PATIENT BIO DATA
Name :- Ayesha Akhtar
Sex :- Female
Occupation:- student
Age:- 20yrs.
Resident:- 259 Model colony, Sialkot.
DOA: 28-10-13
MOA: OPD

3.  Progressive generalized Weakness- for last 6
months
 Fever 10 days
 Bodyaches 6 days
 Vomiting 2 days

4.  6 months back patient started feeling weakness, malaise,
which was on doing daily household work.
 It has progressed since then (disability grade 3)
 There is associated shortness of breath, which progresed
from NYHA class I to NYHA class II over past 6 months. It was
not associated with cough , whistling sounds on breathing or
blood from loss from any site of the body

5.  Fever started 6 days back, was low-grade, not
associated with rigors and chills, it was intermittent.
Relieved only by taking anti pyretic. It was also
associated with body aches, restlessness,
decrease appetite. It was not associated with joint
pain or swelling. There was no body rash
associated with this fever

6.  Vomiting for 2 days
 There have been 3,4 episodes, containing food
contents. It was non-projectile.it was relieved by
anti-emetic drugs.
 Vomiting was associated with intake of food and
water

7. SYSTEMIC REVIEW
 No history of diarrhea, constipation
 No history of mental confusion, fits or any disorientation
or headache.
 No history of cough, sputum
 No history of burning micturition, pain flank, yellowing of
urine or stools.
 No history of rash, allergy, difficult in swallowing food
and discolouration of fingers with cold weather exposure

8. PAST HISTORY
 No evident past medical or surgical history

9. SOCIOECONOMIC
 Low middle class

10. DRUG HISTORY
 Patient taking steroids, left 2 months back

11. EXAMINATION
 General Pysical Examination:-
 A young girl, lying comfortably. Well oriented in
place, person and time, having vitals of:
 BP 110/60 mm Hg
 pulse 92/min,regular no radioradial and radio
femoral delay
 R/R 19/min temp:98.4F
 GCS 15/15
 Pallor ++ Cyanosis –ve
 Jaundice ++ no lymph node palpable
 JVP not raised No Pedal Edema

12. SPECIFIC EXAMINATION
 GIT:- Umbilicus central inverted, flat Soft, Non-tender
abdomen.
 On palpation Spleen is palpable 1-finger breadth below
left sub costal margin. No other viscera palpable.
 On percussion SD and FT are absent
 Bowel sounds +ve.

13. CVS:-
 No visible pulsations, Apex beat in left 5th
intercostal space, medial to mid-clavicular line.
 No thrill, S1+S2+0. no murmur.
 Heart rate is 93/min, regular.

14. CNS:-
 Higher mental functions are normal
 Pupils are B/L equal and reactive to light and
accommodation
 Cranial nerve examination is normal
 Normal motor and sensory examination of both the
upper and the lower limbs
 Reflexes are normal

15. RESPIRATORY SYSTEM
 Normal on Inspection, palpation and percussion.
 Normal vesicular breathing with no added sound

16. DIFFERENTIAL DIAGNOSIS
All types of hemolytic anemias
Portal hypertension
Leuemias
Lymphomas
Mononucleosus
Malaria

17. INVESTIGATIONS

18. INVESTIGATIONS

19. INVESTIGATIONS

20. LFT’S

21. LFTS

22. USG ABDOMEN

23. ANA/ RA

24. FURTHER INVESTIGATIONS
 Coomb’s test, direct and indirect to detect IgG
antibodies
 Hemoglobin electrophoresis

25. TREATMENT
 Replace red cells by Pack cell volume transfusion.
 Cortisteroids
 Plasmaphoresis in severe cases.
 Spleenectomy