24YR OLD FEMALE WITH ANAEMIA

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24 year old female Came to OPD with chief complaints of 

C/O Low grade fever since 5 days 

C/O SOB ( GRADE 2- GRADE 3)

History of present illness : 

History of present illness:

patient was assymptomtic till 5 days and then devloped low grade fever which was not associated with chills 

patient developed Dry cough,non mucous ,non blood tinged 

no H/O cold

no H/O vomiting 

no H/O abdominal pain 

Patient has history of recurrent jaundice (4-5 times un a year )

no H/O bleeding manifestations,herbal medications use 

married at 12 years of age 

2 children : male child delivery c section 2014 

Female child 2016 delivery c section ( 1 unit PRBC transfusion done and then she developed jaundice)

From 2016 to 2021

 6 recurrent jaundice episodes  associated with low grade fever  and generalised weakness.

General examination :

Patient is concious,cooherent,cooperative well oriented to time and place

BP:100/60mmhg

PR:100bpm

temp :100F

spo2 :98% at room air  

palor-+

icterus-+ 

koilonychia-+,

no cyanosis,clubbing ,edema,lymphadenopathy

systemic examination 

CVS : S1S2 heard no thrills and murmurs

RS: BAE + NVBS +

perabdomen : soft,non tender ,no palpable mass 

CNS: all superficial and deep reflxes are normal

INVESTIGATIONS :

HAEMOGRAM :

HB:3.6

TLC:4,800

PCV:15.6

PC: 2.02lakh cells /cumm

SMEAR :RBC- anisopoiklocytosis with hypochromasia,microcytes,normocytes,tear drop cells,pencil forms seen 

LFT : 

TB:1.84

DB:0.32

ALP:87

SGPT:10

A/G RATIO :1.63

SR.CREAT :0.7

SR.NA+:138

K+:2.8

Cl- :96

URINARY ELECTROLYTES 

Spot urinary sodium : 228

Spot urinary potassium :19.6

ULTRASOUND ABDOMEN :

IMPRESSION :

MILD SPLENOMEGALY

ECG

Chest X RAY 

PLAN OF CARE :

1.T.DOLO 650 mg/PO/TID

2.T.PAN 40mg PO/OD

3.T.ZINCOVIT PO/OD

4.T.LIMC66 PO/BD

5.STRICT TEMP CHARTING 4TH hrly

6.NO IV FLUIDS

7.BP,PR,SPO2 MONITORING 4TH hrly

8.INJ.KCL (1ampule = 20 mEq) in 100ml NS/IV/STAT over 2 hours