microcytic hypochromic anaemia

1. PHARMACOTHERAPEUTICS- III
SUBMITTED BY:
MAHESHWARI
IV PHARM D

2. CASE STUDY ON
ANAEMIA

3. SUBJECTIVE
A 06 year old male boy was admitted on
PMCH Erode on 06-12-2018 , with
complaints of fever for past 4 days.

4. HISTORY OF PRESENT ILLNESS:
 H/O fever for past 4 days – intermittent
grade not associated with chills and rigors.
 H/O cough and cold – 1week, yellow, not
blood stained, no foul smell.
 H/O decreased urine output
 H/O cry during micturation.
 H/O loose stools before 1 week
 H/O recurrent respiratory infection (+)

5. PAST HISTORY:
 H/O nebulisation (+)
 H/O hospitalisation at 3 yrs of age.
FAMILY HISTORY:
 H/O TB for his grand father completed
treatment before 4 years.

6. GENERAL EXAMINATION
 conscious ,oriented
 BP : 86/58 mmHg
 PR : 60bpm
Spo2: 87% without O2 and
100% with O2.
Temp: 99.9 F

7. SYSTEMIC EXAMINATION
 CVS - S1S2 Heard
 RS - BAE+ ( wheeze)
 CNS - NFND
 P/A - Soft not tender

8. OBJECTIVE
INVESTIGATION CHART
NAME OF
INVESTIGATION
OBSERVED VALUE NORMAL VALUE
WBC 8.9x109/L 4.5-10.5×109/L
RBC 3.86x1012/L 3.8-5.9×1012/L
HAEMOGLOBIN 7.1g/dl 13.5-17.5g/dl
PLATELETS 275.0109/L 130-400109/L
MCV 58.9 FL 80-100FL
HCT 33.2% 35-50%
MCH 18.6pg 27- 34pg
MCHC 31.4g/dl 33-36g/dl

9. BIOCHEMISTRY
BLOOD UREA 17 mg/dl 10-40 mg/dl
S. CREATININE 0.7mg/dl 0.5-1.2mg/dl
URINE ANALYSIS
COLOUR Pale yellow
REACTION Acidic
ALBUMIN +

10. OTHER TEST:
 CXR : Bronchopneumonia
7/12/2018
BLOOD CULTURE:
 Methicillin resistant staphylococcus
 Amikacin
 Linezolid sensitive
URINE CULTURE
 Klebsilla : 105 CFU/ml [ significant bacteria]
 Amikacin nitrofurantoin
 Gentamycin cefeperazone sensitive
 Piperacillin

11. ASSESMENT
FINAL DIAGNOSIS
Anaemia [ microcytic hypochromic
anaemia]
Bronchopneumonia
Fever for evaluation

12. DRUG CHART
GENERIC NAME DOSE ROA FRQ DATE
06 07 08 09 10 11
Nasal O2 IVF Dextrose
Normal Saline
84ml/hr IV BD √ √ √ √
Inj. Dexamethasone 450mg IV BD √ √ √ √
C. Oseltamivir 15mg Oral 1-0-1 √ √ √ √ √ √
Syp. Zinc Sulfate 20mg Oral 5ml-
5ml-
5ml
√ √ √ √ √ √
Syp.Paracetamol 125mg Oral TDS √ √ √ √
T.Ferrous fumarate+ folic
acid
50mg Oral BD √ √ √ √ √ √
VITAL MONITORING √ √ √ √ √

13. DISCHARGE SUMMARY
The patient was discharged on 13/12/18.
DISCHARGE ADVICE
Syp. Zinc oral 5ml-5ml-5ml
Syp.Paracetamol 125mg SOS
T.Ferrous Fumarate + Folic Acid 50mg TDS
C.Oseltamivir 15mg Oral BD

14. PLAN

15. DIET BASED COUNSELLING
 Vitamin C sources like guavas ,berries oranges
etc should be taken as it maintains healthy
blood vessels and it increases absorption of
iron.
 Vitamin E sources such as cabbage , soybeans
,sprouts, carrots etc should be taken.
 Consume iron rich organ meats like heart ,
kidney of lamb and beef tongue.

16. Foods high in calcium should not be
eaten at the same time as iron rich
foods.
Milk should be avoided as it is not a
good source of iron, in fact milk makes it
harder for the body to absorb iron.

17. BRONCHOPNEUMONIA :
 Take a diet of protein rich foods like eggs,
seafoods as it repairs the damaged tissue.
 Drink more water to flush out waste
products and moisten the tissues.

18. DISEASE BASED COUNSELLING
 Identification for the type of anaemia is important
for the treatment.
 Extend of the disease proceeded and appropriate
co-morbidities should be explained to the patient.
 Sanitation is very important for the patient with the
respiratory tract infection because it may lead to
further infection

19. DRUG BASED COUNSELLING:
 T.PARACETAMOL: Should be adminstered twice a
day. Do not exceed the prescribed dose.
 T.FERROUS FUMERATE: Advised the patient to
take this tablet along with citrus fruit juices to
enhance absorption of iron.
 C.OSELTAMIVIR: Take this medication with food or
milk to minimize stomach upset.

20.  SYRUP.ZINC : It should be taken as whole as its
taste bitter. And it should be taken in a measuring
cup as told by the doctor.

21. THANK YOU