CASE PRESENTATION ON PANCYTOPENIA

1. CASE PRESENTATION ON
PANCYTOPENIA
SUBMITTED BY
METI.BHARATH KUMAR
16DK1T0014
Pharm.D INTERNSHIP

2. DEMOGRAPHIC DETAILS
• NAME: Lakshmi devi
• AGE: 55 years
• GENDER: female
• DEPARTMENT:General medicine
• UNIT:FM-7
• IP NO: 69402
• DOA: 18/12/2021
• CONSULTANT PHYSICIAN: Dr.Nilofar Seema M.D

3. SUBJECTIVE EVIDENCE
• A 55 years female patient was admitted in the female medical ward
unit-7 with the chief complaints of,
breathlessness since 3 days.
generalized swelling of body (pitting type) since 20 days.
abdominal distension which is followed by facial puffiness; not
associated with decreased urine output.
• Past history : k/c/o : paranoid schizophrenia from 20 years and on
regular medication.

4. • Complete blood picture:
HGB: 9.0
RBC: 2.0
WBC: 3.5
PLT: 89
RBS: 185 mg/dl
B.urea: 19 mg/dl
Serum creatinine: 0.5 mg/dl
LFT:
T.B: 5.4
D.B: 1.5
SGPT: 62
SGOT: 95
ALP: 80
• THYROID PROFILE:
T3: 0.25 mg/dl
T4: 0.62 mg/dl
TSH: 3.5 mg/dl
TOTAL PROTEINS: 6.1
LIPID PROFILE TEST:
Cholesterol : 126
Tgs : 103
HDL: 37
LDL: 68
VLDL: 21
VITAMIN B12 : < 50 pg/ml ( 180-920)

5. OBJECTIVE EVIDENCE
2D-ECHO:
• Tachycardia during study
• Good LV systolic function
• N LV filling pattern
• Mild AR
• EF- 75%
USG ABDOMEN: mild to moderate ascites

6. ASSESSMENT
• Based on the subjective and objective evidence the case is confirmed
as “ PANCYTOPENIA WITH GROSS ANEMIA WITH VIT B12
DEFICIENCY”.

7. PLAN OF TREATMENT
MONITOR VITALS DAY 1
• Temp: afebrile
• PR:128/min
• RR: 18 bpm
• BP: 80/50 mm hg
• SPo2: 98 % @ RA
• Cvs: s1s2+ve
• CNS: e4v5m6
• RS: BAE+
Rx
• 1.packed cell transfusion
• 2.inj.taxim 1g IV BD
• 3.inj.pantop 40 mg IV OD
• 4.syrup.haemup 15 ml PO TID
• 5.Inj.noradrenaline 2 amp in 1
unit NS @ 8-10 drops/min
• 6.inj.Lasix 20 mg IV BD
• FBS/PPBS monitor

8. PLAN OF TREATMENT
MONITOR VITALS DAY 2
• Temp: afebrile
• PR:128/min
• RR: 18 bpm
• BP: 90/60 mm hg
• SPo2: 98 % @ RA
• Cvs: s1s2+ve
• CNS: NFND
• RS: BAE+
Rx
• 1.inj.taxim 1g IV BD
• 2.inj.pantop 40 mg IV OD
• 3.syrup.haemup 15 ml PO TID
• 4.Inj.noradrenaline 2 amp in 1 unit
NS @ 8-10 drops/min
• 5.inj.Lasix 20 mg IV BD
• 6.inj.elder vit 1 amp in 100ml NS
• 7.t.bc OD
• 8.t.IFA OD

9. PLAN OF TREATMENT
MONITOR VITALS DAY 3
• Temp: afebrile
• PR:128/min
• RR: 18 bpm
• BP: 90/60 mm hg
• SPo2: 98 % @ RA
• Cvs: s1s2+ve
• CNS: NFND
• RS: BAE+
Rx
• 1.inj.cefotaxime 1g IV BD
• 2.inj.rantac 2cc IV BD
• 3.inj.eldervit 1 amp in 100 ml NS IV
OD
• 4.t.bcomplex OD
• 5.t.ca+2/vit D3 OD
• 6.t.lorazepam 1 mg OD
• 6.t.risperidone+THF 5mg+2mg OD
• 7.t.haloperidol 5 mg1/2-1/2
• 8.inj.ferric carboxymaltose in100
ml NS IV OD

10. DRUG
CHART
S.NO GENERIC NAME BRAND NAME INDICATION DOSE ROA FREQUENCY
1 Cefotaxim Reduce infection 1 g IV BD
2 Pantoprazole Pantop Reduce acidity 40 mg IV OD
3 Furosemide Lasix Reduce
inflammation
20 mg IV BD
4 Multi vitamin Eldervit Vitamin
supplement
1 amp IV OD
5 Iron folic acid Haem up Iron +vitamin
supplement
15 ml PO TID
6 Noradrenaline Bp increase 2 amp IV OD
7 IFA Iron supplement Mineral
supplement
PO OD
8 Bcomplex Vitamin
supplement
PO OD
9 Lorazepam Reduce anxiety 1 mg IV OD
10 Haloperidol Reduce psychotic
condition
5 mg PO BD
11 Riseperidone +
THF
5 mg+2 mg PO OD
12 Ferric
carboxymaltose
Replace iron
stores
500 mg/10
ml
IV OD

11. PHARMACEUTICAL CARE ISSUES
• Lorazepam + risperidone =both increase sedation.
• Haloperidol + risperidone = both increase extrapyramidal symptoms.

12. DISCUSSION
Pancytopenia is a condition in which a person’s body has too few red blood
cells, white blood cells, and platelets. Each of these blood cell types has a
different job in the body:
• Red blood cells carry oxygen throughout your body.
• White blood cells are part of your immune system and help fight off
infections.
• Platelets allow your blood to form clots.
If you have pancytopenia, you have a combination of three different blood
diseases:
• anemia, or low level of red blood cells
• leukopenia, or low level of white blood cells
• thrombocytopenia, or low platelet levels

13. CLINICAL MANIFESTATIONS
• shortness of breath
• pale skin
• fatigue
• weakness
• fever
• dizziness
• easy bruising
• bleeding
• tiny purple spots on your skin,
called petechiae
• larger purple spots on your skin,
called purpura
• bleeding gums and nosebleeds
• fast heart rate

14. CAUSES AND RISK FACTORS
• Pancytopenia starts because of a problem with your bone marrow. This
spongy tissue inside bones is where blood cells are produced. Diseases and
exposure to certain drugs and chemicals can lead to this bone marrow
damage.
• You’re more likely to develop pancytopenia if you have one of these
conditions:
• cancers that affect the bone marrow, such as:
• leukemia
• multiple myeloma
• Hodgkin’s or non-Hodgkin’s lymphoma
• myelodysplastic syndromes
• megaloblastic anemia, a condition in which your body produces larger-than-normal,
immature red blood cells and you have a low red blood cell count

15. • aplastic anemia, a condition in which your body stops making enough new blood cells
• paroxysmal nocturnal hemoglobinuria, a rare blood disease that causes red blood cells to
be destroyed
• viral infections, such as:
• Epstein-Barr virus, which causes mononucleosis
• cytomegalovirus
• HIV
• hepatitis
• malaria
• sepsis (a blood infection)
• diseases that damage bone marrow, such as Gaucher disease
• damage from chemotherapy or radiation treatments for cancer
• exposure to chemicals in the environment, such as radiation, arsenic, or benzene
• bone marrow disorders that run in families
• vitamin deficiencies, such as lack of vitamin B-12 or folate
• enlargement of your spleen, known as splenomegaly
• liver disease
• excess alcohol use that damages your liver
• autoimmune diseases, such as systemic lupus erythematosus

16. COMPLICATIONS
Complications from pancytopenia stem from a lack of red blood cells,
white blood cells, and platelets. These problems can include:
• excess bleeding if platelets are affected.
• increased risk for infections if white blood cells are affected.
• Severe pancytopenia can be life-threatening.

17. DIAGNOSIS
• CBC: complete blood count
• Bone marrow aspiration
TREATMENT
• Treatments for pancytopenia
include:
• drugs to stimulate blood cell
production in your bone marrow.
• blood transfusions to replace red
blood cells, white blood cells, and
platelets.
• antibiotics to treat an infection.
• a bone marrow transplant, also
known as a stem cell transplant,
which replaces damaged bone
marrow with healthy stem cells that
rebuild bone marrow.