A 17 years old female presented with weakness and Jaundice
Dr. Suraiya Akter
MD Resident (Phase-A)
Haematology
BSMMU
Particulars of the patient
Chief complaints
H/O present illness:
According to the statement of the patient,she was reasonably well 15 days back, then she noticed that she was gradually becoming weak and pale. Initially she could perform all activities with little discomfort but she became tired while she did usual daily activities. Along with weakness she occasionally experienced palpitation specially during strenuous activities which was relieved by taking rest.
She also complained of fever for last 5days which was low grade and intermittent in nature ,highest recorded temperature was 100 F.it was not associated with chills and rigor and profuse sweating,subsided by taking paracetamol.dietary habit was normal. Her bladder and bowel habit were normal.
No history of
Continued. . .
History of past illness she had similar episode of attack for 3 to 4 times in last 2 years and for that she had to admit in hospital for 2 times and treated with some medications and several units of washed red cell concentrate .No previous history of radiation therapy,any operation, or other significant chronic illness.
Family history
She was unmarried and had two sisters.no family history of such illness .all her family members were in good health.
Personal History: She was a student.no history of betel nut chewing,smoking or taking alcohol.
Drug history:She took some medications for her illness which she could not mention.
Travel history:No history of travelling in Mymensingh ,Netrokona, Sherpur and hill tract areas.
Menstrual history:Her period was regular with average flow and duration,cycle was 28days.
Socioeconomic condition: She belonged to a middle class family.she used to drink deep tubewell water.sanitation system was good.
Immunization history: She was immunized under EPI schedule and TT schedule.
Cushingoid facies of this patient
Physical examination
Contd:
Systemic examination:
Local temperature was normal,no tenderness,no rigidity.
Spleen was 3cm enlarged from left costal margin along left anterior axillary line towards right iliac fossa,moved with respiration,surface was smooth,border was sharp,non tender,firm in consistency,splenic notch was present in anterior border,incination test was negative.no other organomegaly were present.
Cardio-Vascular system
Respiratory system NAD
Nervous system
Musculoskeletal system
Salient features
What will be the diagnosis ?
Differential diagnosis
1.Autoimmune haemolytic anaemia
2.Hereditary haemolytic anaemia
3. Acute viral hepatitis
Investigations�
| 01/06/19 | 15/03/21 | 18/03/21 |
Hb(g/dl) | 3 | 3.2 | 8.1 |
ESR(mm 1st hr) | 30 | 26 | 25 |
T. RBC count(mill/cumm) | 1 | 0.9 | 2.98 |
MCV(fl) | 112 | 97 | 87.9 |
MCH(pg) | 37 | 30 | 27.2 |
MCHC(g/dl) | 33 | 31 | 30.9 |
T. WBC count(/cumm) | 11,000 | 18,300 | 15.5 |
N(%) | 66 | 72 | 86 |
L(%) | 30 | 23 | 11 |
M(%) | 02 | 03 | 3 |
E(%) | 02 | 02 | 0 |
Ba(%) | 0 | 0 | 0 |
Reticulocyte % | 08 | | 8.15 |
Platelet(/cumm) | 200 | | 165 |
PBF | Severe normocytic normocromic anaemia | | Dimorphic anaemia |
Investigations
�
Indirect: Positive
Investigations:
Now topic discussion on Autoimmune
haemolytic anaemia
Definition:Autoimmune haemolytic anaemia is a rare red blood cell disorder and an immune disorder. It happens when the body produces antibodies that destroy the red blood cells.
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