it is a case study on disorder thrombocytopenia and dengue. detailed study about case with parameters and treatment. it incudes, Medication chart review, Clinical Review, etc. also includes basic concept about thrombocytopenia, and dengue.

1. CASE PRESENTATION
Guided By
Mrs. Hemakshi Chaudhari mam
Dept of Clinical Pharmacy
RCPIPER,SHIRPUR
Presented By
Vaishnavi Kishor Nikte
Dept of Clinical Pharmacy
RCPIPER,SHIRPUR

2. INTRODUCTION
What is thrombocytopenia?
Thrombocytopenia occurs when your blood platelet count is low. Platelets are also called
thrombocytes. This type of blood cell clumps together to form blood clots to help stop bleeding at the
site of a cut or wound. Another name for a blood clot is thrombus.
What causes thrombocytopenia?
•Alcohol use disorder and alcoholism.
•Autoimmune disease which causes ITP. ITP is sometimes associated with other autoimmune
conditions such as lupus.
•Bone marrow diseases, including aplastic anemia, leukaemia, certain lymphomas and myelodysplastic
syndromes.
•Cancer treatments like chemotherapy and radiation therapy.
•Enlarged spleen caused by cirrhosis of the liver or Gaucher disease. The enlarged spleen traps
platelets and other blood cells and prevents them from circulating in the blood stream.
•Exposure to toxic chemicals, including arsenic, benzene and pesticides.
•Medications to treat bacterial infections (antibiotics), seizures (epilepsy) and heart problems, or the
blood thinner heparin.
•Viruses, such as hepatitis C, CMV, EBV and HIV.

3. What are the symptoms of thrombocytopenia?
•Bleeding gums.
•Blood in stool (black, tarry-looking), urine (haematuria) or vomit.
•Heavy menstrual periods.
•Petechiae (tiny red or purple dots on the lower legs that resemble a rash).
•Purpura (purple, red or brown bruises) or bruising easily.
•Rectal bleeding.
Pathophysiology

4. Dengue Fever
Dengue is a viral infection transmitted to humans through the bite of infected mosquitoes. The
primary vectors that transmit the disease are Aedes aegypti mosquitoes and, to a lesser extent, Ae.
albopictus. The virus responsible for causing dengue, is called dengue virus (DENV).
The World Health Organization's 2009 classification divides dengue fever into two groups:
uncomplicated and severe
Dengue hemorrhagic fever was subdivided further into grades I–IV.
1. Grade I is the presence only of easy bruising or a positive tourniquet test in someone with fever.
Grade II is the presence of spontaneous bleeding into the skin and elsewhere.
2. Grade III is the clinical evidence of shock, and grade IV is shock so severe that blood pressure
and pulse cannot be detected.
3. Grades III and IV are referred to as "dengue shock syndrome".

6. PROFORMA OF PATIENT
Name- Mr. XYZ
Gender-Male
Age- 23 yrs.
Weight – 63 Kg
Occupation – Not mentioned
DOA- 28/01/2022
Treatment type - Inpatient
Consulted by - Dr. P.N Dighore sir
Hospital name - I.G.M, hospital of Shirpur
Past history - 2 Dose of Covid vaccine completed
Family history- None
Social history- Alcoholism
Diagnosis- Thrombocytopenia, Dengue

7. PRESENT PATIENT COMPLIANCE
 Fever, with chills from 4 days
 Cough
 Nausea
 Anorexia
 Epistaxis
HISTORY OF PRESENT ILLNESS
A 23 yrs. male came to hospital with compliant of chilled fever with
cough and nausea from 4 days at 28/01/2022.
No history of past disease condition.

8. VITAL SIGNS
BP 120/80 mmHg
PR 90/min
SpO2 98%
PHYSICAL EXAMINATION
CNS- Conscious and Critical
High risk of bleeding
DIAGNOSTIC TEST
HEMOTOLOGICAL TEST
USG ABDOMEN PELVIC
BIOCHEMICAL TEST
PROTHROMBIN TEST

9. Investigation Result Normal Range
Haemoglobin
(Cynmethemoglobin)
14.2gm% M: 14-18gm%
F : 12-16gm%
Total WBCs 5300/ cu.mm 4000 to 10000 / cu.mm
Platelet Count 0.52 lakh/mm3 1.4 - 4.4 lakh/mm3
SEROLOGY
PROTHROMBIN TEST
 Contral Prothrombin Time -12.9 sec
 Patient Prothrombin Time – 14 sec
 International Normalise Time – 1.08 sec

10. USG ABDOMEN & PELVIS
Liver: Mild hepatomegaly (span 16 cm) IS NOTED
Gall Bladder: normal
Pancreas: normal
Spleen: Borderline splenomegaly (12.5 cm) is noted
Right Kidney: Mildly altered cortical echotexture is noted. A 19 * 13mm right renal simple cortical
cyst with 4.4mm calcification within is noted.
Left Kidney: Mildly altered cortical echotexture is noted.
Impression:
- Mild hepatosplenomegaly
- Mildly altered renal cortical echotexture bilaterally
Investigation Result Normal Range
SGPT 48 IU/DL (H) 0.0 – 40 IU/DL
SGOT 98 IU/DL (H) 5.0 – 34 IU/DL

11. MEDICATION PRESCRIBED
Medication API Dose Frequency Route Category/sub
category
INJ. VITAMIN K Phytonadione 2.5-10mg Once in day IV Coagulant
INJ. PAN pantoprazole 40mg Once in day IV antacid
INJ. ONDEM Ondansetron+
PCM
4mg Twice in day IV antiemetic
INJ. ZONAMOX cefoperazone 1.5mg Twice in day IV Antibiotic
INJ.FALCIGO artesunate 60mg Twice in day IV Anti malaria

12. Medication API Dose Frequency Route Category/sub
category
INJ. ELDERVIT Vit.B12, folic
acid, vit.C,
niacinamide
12mg Once in day IV Vitamin
TAB. SYLATE Tranexamic acid,
Etamsylate
500mg Thrice in day ORAL Antihemorrhagic
drug
TAB. CALPOL paracetamol 650mg Once in day ORAL Antipyretic
Syp. Solvin DX Phenylephrine,
Chlorpheniramin
e Maleate and
Dextromethorpha
n Hydrobromide
5 ml Thrice in day Oral

13. PATIENT COUNSELLING
The patient counselling points include lifestyle changes along with dietary
restrictions.
Avoid mosquito bites when traveling in tropical areas by using powerful
plug-in mosquito repellent, even indoors as aedes is day biting mosquito.

14. REFERENCE
 www.1mg.com
 www.webMD.com
 K D Tripathi Essentials of Medical Pharmacology, 8th Edition, Jaypee
Brothers Medical Publication.

15. THANK YOU