Folate dediciency anaemia with liver cirrhosis

1. Case Study
Folate deficiency anaemia, liver
cirrhosis

2. Case introduction
• Sex: Male
• Age: 45

3. Complaints
• Fatigue
• Lightheadedness
• Shortness of breath
• Decreased appetite
• Headache
• Nausea
• Mild pain under the right part of the ribcage
• Зүрх дэлсэх/Heart palpitations?
• Abdominal bloating

4. Physical examination
• Breaths PM 16, Beats PM 72, AP R: 140/100;
L: 150/100, t° 36,4° C
• Dry, pale skin
• Decreased muscle tone
• Slight enlargement of liver by percussion
• Fluid level by percussion and palpation

5. Lab findings
• RBC – 3,9 *1012
• ESR – 27 mm/hour
• WBC - 3,8*109
• MCV – 76 fl
• MCH – 26 pg

6. Biochemical findings
• AST 48
• ALT 35
• ALP 310 U/L
• TBIL 22,1 mmol/L

7. Ultrasonography
• Slight enlargement of liver and spleen
• Fluid level in the abdominal cavity

8. ECG
• Sinus rhythm
• BPM 74
• Left axis deviation