Uploaded byDR. METI.BHARATH KUMAR
CASE PRESENTATION ON PANCYTOPENIA
A 55-year-old female was admitted with complaints of breathlessness, generalized swelling, and abdominal distension. Laboratory tests revealed pancytopenia (low red blood cells, white blood cells, and platelets), along with vitamin B12 deficiency. She was diagnosed with pancytopenia and gross anemia due to vitamin B12 deficiency. Her treatment plan included blood transfusions, antibiotics, diuretics, vitamins, and medications to stimulate blood cell production and manage her psychiatric conditions. Close monitoring was needed due to potential drug interactions and complications from her low blood cell counts.
More Related Content
Similar to CASE PRESENTATION ON PANCYTOPENIA
More from DR. METI.BHARATH KUMAR
CASE PRESENTATION ON PANCYTOPENIA
- 1. CASE PRESENTATION ON PANCYTOPENIA SUBMITTEDBY 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 • A55 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 bloodpicture: 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: • Tachycardiaduring study • Good LV systolic function • N LV filling pattern • Mild AR • EF- 75% USG ABDOMEN: mild to moderate ascites
- 6. ASSESSMENT • Based onthe subjective and objective evidence the case is confirmed as “ PANCYTOPENIA WITH GROSS ANEMIA WITH VIT B12 DEFICIENCY”.
- 7. PLAN OF TREATMENT MONITORVITALS 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 MONITORVITALS 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 MONITORVITALS 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 NAMEBRAND 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 acondition 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 • shortnessof 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 RISKFACTORS • 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 pancytopeniastem 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: completeblood 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.