40Y OLD WITH SEVERE ANAEMIA
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9 Feb 2022
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A 40 Y FEMALE WITH MULTIPLE LIFE EVENTS SINCE CHILDHOOD
HOPI
A 40yr old female who was born out of consaginous marriage grade III through a normal vaginal delivery at her mother's sister house. She immediately cried and was breast fed for 1year.
Her immunization is not known .
Since childhood she used to eat only one meal per day though she had a good appetite because of weakness, she had no energy to eat.
She used to sway side by side while walking,sometimes fell down and again she used to get up on her own.
She used to get ready to school by herself.(wearing uniform,combing hair)
She used to repeat her standard almost 2-3 times. She studied upto 10th std and gave up studies due to lack of interest.
She attained menarche at the age of 14yrs with normal flow 4-5 days/month with no clots. LMP- 5/2/2022
Once she complained of heavy bleeding for a month for which they went to local mbbs doctor who provided medications and her bleeding was relieved.
Now since 6 months ,she is having heavy bleeding per vagina during her cycles with clots for which they took medication which was prescribed earlier which was not relieved.
Then they went to local hospital where she was diagnosed as anemic and blood transfusion was suggested. But transfusion wasn't done due to unknown reasons.
Then she came to our hospital.
PEDIGREE CHART
PAST HISTORY
Not a known case of DM, Hypertension, thyroid, Asthma, TB, Epilepsy.
FAMILY HISTORY
Not significant
PERSONAL HISTORY
Diet mixed
Appetite normal
Sleep normal
Bowel and bladder movements regular
No addictions and no known allergies
GENERAL EXAMINATION
Patient is conscious,coherent and cooperative, thin built and malnourished
Pallor ++
No icterus, cyanosis, clubbing, edema, lymphadenopathy
VITALS
Temp-Afebrile
PR - 108bpm
BP-100/60 mmHg
Spo2 99%
GRBS - 87mg/dl
SYSTEMIC EXAMINATION
Frontal bossing, few hyperpigmented patches on face and crowded teeth +
Neck - diffuse goiter present
CVS
Inspection -
JVP raised
Apical impulse diffuse in 5th and 6th IC space
Palpation - thrills and para sternal haeve +
Apex beat in mid clavicular line
Auscultation - loud S1 S2 + at pulmonary and tricuspid area , systolic murmer +
CNS Examination
PT - c/c non Co operative
MMSE 20/30
Speech normal
Cranial Nerve examination:
CN 1 Not done
CN 2 Normal pupillary reflex
CN 3, 4, 6 Upward and lateral eye movement restricted ( She was closing eyes)
CN 5 Weak
CN 7 Weak
CN 8,9,10,11,12 Not done as she was not co operative
Sensory examination Not done as uncooperative
Motor system
Tone - Rt Lt
U/L N N
L/L N N
Power
Rt Lt
U/L 4/5 4/5
L/L 4/5 4/5
Reflex
Biceps 3+ 3+
Triceps 3+ 3+
Supinator 3+ 3+
Knee 3+ 3+
Ankle 3+ 3+
Plantar dorsiflexion
Sensory examination:
Pain felt
Vibration present
Joint position Present
Stereognosis present
Cerebral examination:
Gait - Swaying to sides present but decreased
Finger nose test positive
Dysdiadokinesia positive
RS - BAE +
P/A - soft non tender
Now she developed Ascites
INVESTIGATION:
HB- 1.7%
TLC - 13,100
N/L/E/M/B/- 81/06/03/10/0
PCB - 6.8%
MCV - 57.1
MCH- 14.3
MCHC-25
RDW-CV - 28
RDW - SD - 56.5
RBC - 1.19 MILLION
PLT - 74,000
BGT - O +ve
Sr.cretinine- 1.4 mg/dl
Na+ - 139
CL - 96
K- 2.9
LFT
TB - 1mg/dl
DB - 0.2,ID - 0.8
ALT - 27, AST - 28
ALP - 114
TP - 6.9
ALB - 3.3
GLB - 3.6
Thyroid profile
T3-0.6
T4-10.72
TSH-4.16
ECG
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