SlideShare a Scribd company logo
CASE PRESENTATION
Afreen Nasir
PATIENT DEMOGRAPHY
IP No. : 121901740 DOA : 20/12/19 DOD : 31/12/2019
Age : 20 YEARS Ward : 4th Department : Medicine
Sex : Female
COMPLAINTS ON ADMISSION
• C/o giddiness & weakness since last week (from date of admission ) , c/o heavy
menstrual bleeding , joint pain, oral ulcer.
HISTORY OF PRESENT ILLNESS :
• H/o amenorrhea – 2 months ago , gum bleeding , weight loss + ( 10 kg lost in 6
months) , rashes on upper – lower limbs 1 day back.
• Menstrual history – 28-35 days cycle , 3-4 pad change.
PATIENT HISTORY
• Past medical History -
No H/O HTN , T2DM , hypothyroidism , epilepsy
H/o dengue 1 yr back
• Family History – Nothing significant
• Allergy - NKA
• Medication history – 3 pint PRBC transfusion
• Social History –Nothing significant
• Appetite: Reduce Sleep: N Bowel-Bladder: Normal &regular Diet: veg
GENERAL PHYSICAL EXAMINATION
• Vital signs :(20/12/19)
BP : 140/70mmHg HR: 90 beats/min SPO2=98% RA
• Patient is moderately built , well nourished , conscious , well oriented to TPP
• PICCKLE : absent
SYSTEMIC EXAMINATION
• HEENT – normal
• CNS- HMF +
• RS- normal breath sound +
• Par abdomen – soft N/T
• CVS - S1 S2+
PROVISIONAL DIAGNOSIS
• Δes menorrhagia
LABORATORY EXAMINATION
Tests Performed 20/12 23/12 26/12 28/12 Normal values
Hemogram
Hgb 4.2 4.2 4.9 6.0 F= 12.3-15.5 g/dL
PCV 17 F = 36-45%
RBC 2.6 2.4 F = 3.5 – 4.5 × 10⁵ / mm³
Platelets 21000 5000 4000 1000 1.5-4.5 lakhs/mm³
MCH 18 19 27-32 pg / cell
MCV 75 72 80-96 fL
MCHC 22 24 33 – 35.5 g/dL
ESR 110 110 F= 1-20 mm /hr
WBC 3920 3900 3990 4201 4000-11000/mm³
Neutrophils 64 63 59 62 45-73%
Eosinophils 02 1 02 01 0-4%
Lymphocytes 29 27 24 31 20-40%
Basophils 00 00 00 00 0-1 %
Monocytes 9 7 4 3 2-8%
Tests Performed 20/12 23/12 26/12 28/12 Normal values
VitB12 183 180- 914 pg/ml
Ferritin 10 F= 11-307 ng/ml
Sr.Iron 35 F= 37- 145 microgram / dL
Transferrin 310 200 – 300 mg/dL
Transferrin Saturation 18 20-50%
Reticulocyte count 3.0 0.5 – 2.5 %
UIBC 115 112-346 microgram/dL
TIBC 252 250-450 microgram/dL
Lipid Profile : HDL 24 > 65 mg/dl
RFT
S. creatinine 0.5 0.5 0.4 F= 0.5-0.9 mg/dL
BUN 10 10 10 7-20 mg/dl
Sr. Sodium 140 140 139 136-145 mEq/L
Sr .Potassium 4.4 3.8 3.8 3.5 – 5.1 mEq/L
Sr. Chloride 112 111 105 97-114 mEq/L
Tests Performed 20/12 23/12 26/12 28/12 Normal values
LFT
Albumin 4.4 4.8 3.5-5.5g/dL
Globulin 3.0 2.7 2.5-4.5 g/dL
ALP 126 119 30-120 unit/L
SGOT/AST 21 21 10-35 U/L
SGPT /ALT 11 10 <35 U/L
T. Bilirubin 0.6 0.7 Up to 1.2 mg/L
Sr. Direct bilirubin 0.6 0.5 0.2 mg/dL
GGT 42 44 1-94 U/L
PT 12.4 11.1 – 13.1 sec
S . Total protein 6.9 6.6 – 8.7 g/dl
INR 0.91 0.9-1.1
Biochemistry
LDH 256 265 F = 135 – 214 U/L
ANA +
Impression : Severe microcytic hypochromic iron deficiency anemia with leukopenia & severe
thrombocytopenia.
FINAL DIAGNOSIS
• Patient is diagnosed with Systemic lupus erythematosus ( non renal).
TREATMENT GOALS
• Patient specific –
-Improve QOL
-Selecting cost effective medicine & minimizing side effects of medicines
• Disease specific –
- Control the acute symptom of SLE & protect organs by decreasing inflammation
- Decreasing autoimmune activity in body
- Bringing the abnormal blood parameters to normal
TREATMENT CHART
• Medicine
• prescribed
• Generic name
• Dose
• Freq
• Route
• Indications
• Start date
• Stop date
Medicine
prescribed
Dose Freq Route 20 21 22 23 24 25 26 27 28 29 30 31
T. HCQ HYDROXYCHL
OROQUINE
200mg 1-0-1 P/O + + +
T.
MYCOPHEN
OLATE
MOFETIL
500mg 1-0-1
29 (1-1-1)
’’ + + + + +
Inj.
METHYLPRE
DNISOLONE
1g in
100 ml
NS
1-0-0 IV + +
T. Wysolone PREDNISOLON
E
30mg OD PO + + + + + + + + +
T. Fe + FA FERROUS
SULPHATE +
FOLIC ACID
200mg
/5mg
1-0-1 p/o + + + + + + + + + + + +
T. PCT ACETAMINOP
HEN
500mg 1-1-1 P/O + +
Zytee Gel CHOLINE
SALICYLATE
1 FTU 1-1-1 Topical + + + + + + + + + + + +
Medicine
prescribed
Generic name Dose Freq Route 27 28 29 30 31
Inj. Optineuron Cyanocobalamin (B12), D-
Panthenol (Vit B5), Pyridoxine
(Vit B6), Riboflavin (Vit B2),
Thiamine(vit B1),
Nicotinamide (vit B3)
1 amp in 100 ml
NS
B1-100mg
B2 -5mg
B3- 100mg
B5- 50mg
B6-100mg
B12- 1000mcg
OD IV + + + + +
PROGRESS CHART
Date BP (mmHg) Pulse
(Beats/min)
SPO2 % Complaints Notes
21/12/19 100/70 80 97 Rashes over limbs CVS: S1S2 + , CNS : HMF + , PA : soft NT , RS :
B/L NVBS +
22/12/19 110/70 82 95 ’’
23/12/19 100/80 80 Fever , headache ’’ Temp: 38° C ( Febrile)
24/12/19 110/70 80 97 ’’
25/12/19 110/70 83 98 ’’
28/12/19 100/70 81 98 Fever ’’ Temp : 38° C
31/12/19 100/70 79 98 ’’
CLINICAL PHARMACIST NOTES / INTERVENTION
• Drug – drug interactions :
• Drug – food interactions :
• Advice to Physician : Since patient is on steroid therapy which may cause Osteoporosis so
shall we include CALCIUM & VITAMIN D supplement in the prescription
RANGE INTERACTIONS REASON
Major Ferrous sulphate + Mycophenolate Ferrous sulphate ↓ effect of
mycophenolate by inhibiting GI
absorption
Major HCQ + Mycophenolate Both ↑ immunosuppressive effects
RANGE INTERACTIONS REASON
Moderate HCQ + Grape fruit Grape fruit ↑ blood level of HCQ causing irregular
heart beat
DISCHARGE MEDICATION
Medicine prescribed Generic name Dose /
Route
Frequency/ Duration Possible side effects
T. MYCOPHENOLATE
MOFETIL
500mg
P/o
1-1-1 × 1 month Headache , fever, abd pain
T. HCQ HYDROXYCHLOROQUIN
E
200mg
P/O
1-0-1 × 1 month Nausea , taste disturbance
T.PCT PARACETAMOL (
ACETAMINOPHEN)
500mg p.r.n × 1 week stomach pain , ulcer in mouth
T. Fe + FA FERROUS SULPHATE +
FOLIC ACID
200mg
+ 5mg
1-0-1 × 30 days constipation/ loose motion , dark color
stool
PATIENT COUNSELLING
• Disease
• Medication
• Diet
• Lifestyle modification

More Related Content

Similar to Case Presentation: Severe microcytic hypochromic iron deficiency anemia with leukopenia & severe thrombocytopenia.

5. a case study on rheumatoid arthritis
5. a case study on rheumatoid arthritis5. a case study on rheumatoid arthritis
5. a case study on rheumatoid arthritis
Dr. Ajita Sadhukhan
 
Cva case stroke
Cva case strokeCva case stroke
Cva case stroke
Umme Habeeba A Pathan
 
RPGN.pptx
RPGN.pptxRPGN.pptx
RPGN.pptx
NitariRahmi
 
13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea
13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea
13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea
Dr. Ajita Sadhukhan
 
Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Soroy Lardo
 
MI is cardiovascular disorder with infarction in cardiac muscles which leads ...
MI is cardiovascular disorder with infarction in cardiac muscles which leads ...MI is cardiovascular disorder with infarction in cardiac muscles which leads ...
MI is cardiovascular disorder with infarction in cardiac muscles which leads ...
Bindu238662
 
Laporan Jaga RSPAD (Jessica Putri Natalia S)
Laporan Jaga RSPAD (Jessica Putri Natalia S)Laporan Jaga RSPAD (Jessica Putri Natalia S)
Laporan Jaga RSPAD (Jessica Putri Natalia S)
soroylardo1
 
Laporan Jaga CRBSI.pptx
Laporan Jaga CRBSI.pptxLaporan Jaga CRBSI.pptx
Laporan Jaga CRBSI.pptx
YuyunRasulong1
 
6. a case study on rheumatoid arthritis
6. a case study on rheumatoid arthritis6. a case study on rheumatoid arthritis
6. a case study on rheumatoid arthritis
Dr. Ajita Sadhukhan
 
Case Presentation ,,Mubarek (2).pptx
Case Presentation ,,Mubarek (2).pptxCase Presentation ,,Mubarek (2).pptx
Case Presentation ,,Mubarek (2).pptx
SHIKURYASIN1
 
Nephrotic syndrome
Nephrotic syndromeNephrotic syndrome
Nephrotic syndrome
Akshaya M
 
Fever with rash
Fever with rashFever with rash
Fever with rash
BINOD BISWAJEET ROUT
 
CKD WITH MALARIA & ACUTE GE
CKD WITH MALARIA & ACUTE GECKD WITH MALARIA & ACUTE GE
CKD WITH MALARIA & ACUTE GE
SKSsah
 
10. a case study on ccf with htn
10. a case study on ccf with htn10. a case study on ccf with htn
10. a case study on ccf with htn
Dr. Ajita Sadhukhan
 
Case Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complicationsCase Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complications
ShivankAgrawal5
 
CASE PRESENTATION ON ACUTE PANCREATITIS
CASE PRESENTATION ON ACUTE PANCREATITISCASE PRESENTATION ON ACUTE PANCREATITIS
CASE PRESENTATION ON ACUTE PANCREATITIS
DR. METI.BHARATH KUMAR
 
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...
 PHARM-D  INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO... PHARM-D  INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...
DR. METI.BHARATH KUMAR
 
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...
HariSedai
 
Juvenile dermatomyositis.pptx
Juvenile dermatomyositis.pptxJuvenile dermatomyositis.pptx
Juvenile dermatomyositis.pptx
Shah Prakashman
 
Diabetes of stout people
Diabetes of stout peopleDiabetes of stout people
Diabetes of stout people
Usama Ragab
 

Similar to Case Presentation: Severe microcytic hypochromic iron deficiency anemia with leukopenia & severe thrombocytopenia. (20)

5. a case study on rheumatoid arthritis
5. a case study on rheumatoid arthritis5. a case study on rheumatoid arthritis
5. a case study on rheumatoid arthritis
 
Cva case stroke
Cva case strokeCva case stroke
Cva case stroke
 
RPGN.pptx
RPGN.pptxRPGN.pptx
RPGN.pptx
 
13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea
13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea
13. a case study on convulsions in a kco epilepsy with lactational amenorrhoea
 
Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016
 
MI is cardiovascular disorder with infarction in cardiac muscles which leads ...
MI is cardiovascular disorder with infarction in cardiac muscles which leads ...MI is cardiovascular disorder with infarction in cardiac muscles which leads ...
MI is cardiovascular disorder with infarction in cardiac muscles which leads ...
 
Laporan Jaga RSPAD (Jessica Putri Natalia S)
Laporan Jaga RSPAD (Jessica Putri Natalia S)Laporan Jaga RSPAD (Jessica Putri Natalia S)
Laporan Jaga RSPAD (Jessica Putri Natalia S)
 
Laporan Jaga CRBSI.pptx
Laporan Jaga CRBSI.pptxLaporan Jaga CRBSI.pptx
Laporan Jaga CRBSI.pptx
 
6. a case study on rheumatoid arthritis
6. a case study on rheumatoid arthritis6. a case study on rheumatoid arthritis
6. a case study on rheumatoid arthritis
 
Case Presentation ,,Mubarek (2).pptx
Case Presentation ,,Mubarek (2).pptxCase Presentation ,,Mubarek (2).pptx
Case Presentation ,,Mubarek (2).pptx
 
Nephrotic syndrome
Nephrotic syndromeNephrotic syndrome
Nephrotic syndrome
 
Fever with rash
Fever with rashFever with rash
Fever with rash
 
CKD WITH MALARIA & ACUTE GE
CKD WITH MALARIA & ACUTE GECKD WITH MALARIA & ACUTE GE
CKD WITH MALARIA & ACUTE GE
 
10. a case study on ccf with htn
10. a case study on ccf with htn10. a case study on ccf with htn
10. a case study on ccf with htn
 
Case Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complicationsCase Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complications
 
CASE PRESENTATION ON ACUTE PANCREATITIS
CASE PRESENTATION ON ACUTE PANCREATITISCASE PRESENTATION ON ACUTE PANCREATITIS
CASE PRESENTATION ON ACUTE PANCREATITIS
 
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...
 PHARM-D  INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO... PHARM-D  INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...
 
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...
Final presentation on Acute kidney injury AKI and Chronic kidney disease CKD ...
 
Juvenile dermatomyositis.pptx
Juvenile dermatomyositis.pptxJuvenile dermatomyositis.pptx
Juvenile dermatomyositis.pptx
 
Diabetes of stout people
Diabetes of stout peopleDiabetes of stout people
Diabetes of stout people
 

More from Dr. Afreen Nasir

A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...
A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...
A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...
Dr. Afreen Nasir
 
PharmD Pharmacology 2 instruments name .pdf
PharmD Pharmacology 2 instruments name .pdfPharmD Pharmacology 2 instruments name .pdf
PharmD Pharmacology 2 instruments name .pdf
Dr. Afreen Nasir
 
Clinical pharmacy book by parthasarathi.pdf
Clinical pharmacy book by  parthasarathi.pdfClinical pharmacy book by  parthasarathi.pdf
Clinical pharmacy book by parthasarathi.pdf
Dr. Afreen Nasir
 
Tortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdf
Tortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdfTortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdf
Tortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdf
Dr. Afreen Nasir
 
Case Presentation: Extravasation.pptx Onco
Case Presentation: Extravasation.pptx OncoCase Presentation: Extravasation.pptx Onco
Case Presentation: Extravasation.pptx Onco
Dr. Afreen Nasir
 
Case Presentation: Cephalosporins.pptx Onco
Case Presentation: Cephalosporins.pptx OncoCase Presentation: Cephalosporins.pptx Onco
Case Presentation: Cephalosporins.pptx Onco
Dr. Afreen Nasir
 
Case Presentation: Aminoglycoside.pptx Onco
Case Presentation: Aminoglycoside.pptx OncoCase Presentation: Aminoglycoside.pptx Onco
Case Presentation: Aminoglycoside.pptx Onco
Dr. Afreen Nasir
 
Giudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdfGiudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdf
Dr. Afreen Nasir
 
Journal club: Practice Pattern of Hemodialysis
Journal club: Practice Pattern of HemodialysisJournal club: Practice Pattern of Hemodialysis
Journal club: Practice Pattern of Hemodialysis
Dr. Afreen Nasir
 
e poster: Awareness on organ donation.pdf
e poster: Awareness on organ donation.pdfe poster: Awareness on organ donation.pdf
e poster: Awareness on organ donation.pdf
Dr. Afreen Nasir
 
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Dr. Afreen Nasir
 
Case Presentation: Cryptococcal Meningitis
Case Presentation: Cryptococcal MeningitisCase Presentation: Cryptococcal Meningitis
Case Presentation: Cryptococcal Meningitis
Dr. Afreen Nasir
 
CASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHD
CASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHDCASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHD
CASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHD
Dr. Afreen Nasir
 
CASE PRESENTATION: UPPER RESIRATORY TRACT INFECTION
CASE PRESENTATION:  UPPER RESIRATORY TRACT INFECTIONCASE PRESENTATION:  UPPER RESIRATORY TRACT INFECTION
CASE PRESENTATION: UPPER RESIRATORY TRACT INFECTION
Dr. Afreen Nasir
 
Journal club on Drug Utilization Pattern in ICU
Journal club on Drug Utilization Pattern in ICUJournal club on Drug Utilization Pattern in ICU
Journal club on Drug Utilization Pattern in ICU
Dr. Afreen Nasir
 
Journal club on DUE of Corticosteroids.pdf
Journal club on DUE of Corticosteroids.pdfJournal club on DUE of Corticosteroids.pdf
Journal club on DUE of Corticosteroids.pdf
Dr. Afreen Nasir
 
A study on drug utilisation evaluation of Bronchodilators using defined daily...
A study on drug utilisation evaluation of Bronchodilators using defined daily...A study on drug utilisation evaluation of Bronchodilators using defined daily...
A study on drug utilisation evaluation of Bronchodilators using defined daily...
Dr. Afreen Nasir
 
Case Presentation: Accelarated HTN, CKD, Bronchial asthama
Case Presentation: Accelarated HTN, CKD, Bronchial asthama Case Presentation: Accelarated HTN, CKD, Bronchial asthama
Case Presentation: Accelarated HTN, CKD, Bronchial asthama
Dr. Afreen Nasir
 

More from Dr. Afreen Nasir (18)

A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...
A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...
A Drug Utilization Evaluation of Bronchodilators Using a Defined Daily Dose M...
 
PharmD Pharmacology 2 instruments name .pdf
PharmD Pharmacology 2 instruments name .pdfPharmD Pharmacology 2 instruments name .pdf
PharmD Pharmacology 2 instruments name .pdf
 
Clinical pharmacy book by parthasarathi.pdf
Clinical pharmacy book by  parthasarathi.pdfClinical pharmacy book by  parthasarathi.pdf
Clinical pharmacy book by parthasarathi.pdf
 
Tortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdf
Tortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdfTortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdf
Tortora PRINCIPLES OF ANATOMY AND PHYSIOLOGY - Tortora - 14th Ed.pdf
 
Case Presentation: Extravasation.pptx Onco
Case Presentation: Extravasation.pptx OncoCase Presentation: Extravasation.pptx Onco
Case Presentation: Extravasation.pptx Onco
 
Case Presentation: Cephalosporins.pptx Onco
Case Presentation: Cephalosporins.pptx OncoCase Presentation: Cephalosporins.pptx Onco
Case Presentation: Cephalosporins.pptx Onco
 
Case Presentation: Aminoglycoside.pptx Onco
Case Presentation: Aminoglycoside.pptx OncoCase Presentation: Aminoglycoside.pptx Onco
Case Presentation: Aminoglycoside.pptx Onco
 
Giudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdfGiudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdf
 
Journal club: Practice Pattern of Hemodialysis
Journal club: Practice Pattern of HemodialysisJournal club: Practice Pattern of Hemodialysis
Journal club: Practice Pattern of Hemodialysis
 
e poster: Awareness on organ donation.pdf
e poster: Awareness on organ donation.pdfe poster: Awareness on organ donation.pdf
e poster: Awareness on organ donation.pdf
 
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
 
Case Presentation: Cryptococcal Meningitis
Case Presentation: Cryptococcal MeningitisCase Presentation: Cryptococcal Meningitis
Case Presentation: Cryptococcal Meningitis
 
CASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHD
CASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHDCASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHD
CASE PRESENTATION : T2DM , HTN, ACS/UA , HYPOTHYROIDISM ,IHD
 
CASE PRESENTATION: UPPER RESIRATORY TRACT INFECTION
CASE PRESENTATION:  UPPER RESIRATORY TRACT INFECTIONCASE PRESENTATION:  UPPER RESIRATORY TRACT INFECTION
CASE PRESENTATION: UPPER RESIRATORY TRACT INFECTION
 
Journal club on Drug Utilization Pattern in ICU
Journal club on Drug Utilization Pattern in ICUJournal club on Drug Utilization Pattern in ICU
Journal club on Drug Utilization Pattern in ICU
 
Journal club on DUE of Corticosteroids.pdf
Journal club on DUE of Corticosteroids.pdfJournal club on DUE of Corticosteroids.pdf
Journal club on DUE of Corticosteroids.pdf
 
A study on drug utilisation evaluation of Bronchodilators using defined daily...
A study on drug utilisation evaluation of Bronchodilators using defined daily...A study on drug utilisation evaluation of Bronchodilators using defined daily...
A study on drug utilisation evaluation of Bronchodilators using defined daily...
 
Case Presentation: Accelarated HTN, CKD, Bronchial asthama
Case Presentation: Accelarated HTN, CKD, Bronchial asthama Case Presentation: Accelarated HTN, CKD, Bronchial asthama
Case Presentation: Accelarated HTN, CKD, Bronchial asthama
 

Recently uploaded

KEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docxKEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docx
NX Healthcare
 
Rate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdfRate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdf
Rajarambapu College of Pharmacy Kasegaon Dist Sangli
 
DRAFT Ventilator Rapid Reference version 2.4.pdf
DRAFT Ventilator Rapid Reference  version  2.4.pdfDRAFT Ventilator Rapid Reference  version  2.4.pdf
DRAFT Ventilator Rapid Reference version 2.4.pdf
Robert Cole
 
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DR Jag Mohan Prajapati
 
HUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COM
HUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COMHUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COM
HUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COM
priyabhojwani1200
 
Unlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdfUnlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdf
Lift Ability
 
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to Care
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareLGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to Care
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to Care
VITASAuthor
 
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
The Lifesciences Magazine
 
Vicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdfVicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdf
Arunima620542
 
Gemma Wean- Nutritional solution for Artemia
Gemma Wean- Nutritional solution for ArtemiaGemma Wean- Nutritional solution for Artemia
Gemma Wean- Nutritional solution for Artemia
smuskaan0008
 
Luxurious Spa In Ajman Chandrima Massage Center
Luxurious Spa In Ajman Chandrima Massage CenterLuxurious Spa In Ajman Chandrima Massage Center
Luxurious Spa In Ajman Chandrima Massage Center
Chandrima Spa Ajman
 
The positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experienceThe positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experience
SGRT Community
 
Top Rated Massage Center In Ajman Chandrima Spa
Top Rated Massage Center In Ajman Chandrima SpaTop Rated Massage Center In Ajman Chandrima Spa
Top Rated Massage Center In Ajman Chandrima Spa
Chandrima Spa Ajman
 
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdfInnovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
eurohealthleaders
 
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdfHow Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
Dharma Homoeopathy
 
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyDr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
R3 Stem Cell
 
Feeding plate for a newborn with Cleft Palate.pptx
Feeding plate for a newborn with Cleft Palate.pptxFeeding plate for a newborn with Cleft Palate.pptx
Feeding plate for a newborn with Cleft Palate.pptx
SatvikaPrasad
 
U Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdf
U Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdfU Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdf
U Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdf
Jokerwigs arts and craft
 
NKTI Annual Report - Annual Report FY 2022
NKTI Annual Report - Annual Report FY 2022NKTI Annual Report - Annual Report FY 2022
NKTI Annual Report - Annual Report FY 2022
nktiacc3
 
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
nirahealhty
 

Recently uploaded (20)

KEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docxKEY Points of Leicester travel clinic In London doc.docx
KEY Points of Leicester travel clinic In London doc.docx
 
Rate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdfRate Controlled Drug Delivery Systems.pdf
Rate Controlled Drug Delivery Systems.pdf
 
DRAFT Ventilator Rapid Reference version 2.4.pdf
DRAFT Ventilator Rapid Reference  version  2.4.pdfDRAFT Ventilator Rapid Reference  version  2.4.pdf
DRAFT Ventilator Rapid Reference version 2.4.pdf
 
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
DELIRIUM BY DR JAGMOHAN PRAJAPATI.......
 
HUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COM
HUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COMHUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COM
HUMAN BRAIN.pptx.PRIYA BHOJWANI@GAMIL.COM
 
Unlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdfUnlocking the Secrets to Safe Patient Handling.pdf
Unlocking the Secrets to Safe Patient Handling.pdf
 
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to Care
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareLGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to Care
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to Care
 
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...
 
Vicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdfVicarious movements or trick movements_AB.pdf
Vicarious movements or trick movements_AB.pdf
 
Gemma Wean- Nutritional solution for Artemia
Gemma Wean- Nutritional solution for ArtemiaGemma Wean- Nutritional solution for Artemia
Gemma Wean- Nutritional solution for Artemia
 
Luxurious Spa In Ajman Chandrima Massage Center
Luxurious Spa In Ajman Chandrima Massage CenterLuxurious Spa In Ajman Chandrima Massage Center
Luxurious Spa In Ajman Chandrima Massage Center
 
The positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experienceThe positive impact of SGRT – The Berkshire Cancer Centre experience
The positive impact of SGRT – The Berkshire Cancer Centre experience
 
Top Rated Massage Center In Ajman Chandrima Spa
Top Rated Massage Center In Ajman Chandrima SpaTop Rated Massage Center In Ajman Chandrima Spa
Top Rated Massage Center In Ajman Chandrima Spa
 
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdfInnovative Minds France's Most Impactful Healthcare Leaders.pdf
Innovative Minds France's Most Impactful Healthcare Leaders.pdf
 
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdfHow Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
How Effective is Homeopathic Medicine for Anxiety and Stress Relief.pdf
 
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyDr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in Cardiology
 
Feeding plate for a newborn with Cleft Palate.pptx
Feeding plate for a newborn with Cleft Palate.pptxFeeding plate for a newborn with Cleft Palate.pptx
Feeding plate for a newborn with Cleft Palate.pptx
 
U Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdf
U Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdfU Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdf
U Part Wigs_ A Natural Look with Minimal Effort Jokerwigs.in.pdf
 
NKTI Annual Report - Annual Report FY 2022
NKTI Annual Report - Annual Report FY 2022NKTI Annual Report - Annual Report FY 2022
NKTI Annual Report - Annual Report FY 2022
 
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...
 

Case Presentation: Severe microcytic hypochromic iron deficiency anemia with leukopenia & severe thrombocytopenia.

  • 2. PATIENT DEMOGRAPHY IP No. : 121901740 DOA : 20/12/19 DOD : 31/12/2019 Age : 20 YEARS Ward : 4th Department : Medicine Sex : Female
  • 3. COMPLAINTS ON ADMISSION • C/o giddiness & weakness since last week (from date of admission ) , c/o heavy menstrual bleeding , joint pain, oral ulcer. HISTORY OF PRESENT ILLNESS : • H/o amenorrhea – 2 months ago , gum bleeding , weight loss + ( 10 kg lost in 6 months) , rashes on upper – lower limbs 1 day back. • Menstrual history – 28-35 days cycle , 3-4 pad change.
  • 4. PATIENT HISTORY • Past medical History - No H/O HTN , T2DM , hypothyroidism , epilepsy H/o dengue 1 yr back • Family History – Nothing significant • Allergy - NKA • Medication history – 3 pint PRBC transfusion • Social History –Nothing significant • Appetite: Reduce Sleep: N Bowel-Bladder: Normal &regular Diet: veg
  • 5. GENERAL PHYSICAL EXAMINATION • Vital signs :(20/12/19) BP : 140/70mmHg HR: 90 beats/min SPO2=98% RA • Patient is moderately built , well nourished , conscious , well oriented to TPP • PICCKLE : absent SYSTEMIC EXAMINATION • HEENT – normal • CNS- HMF + • RS- normal breath sound + • Par abdomen – soft N/T • CVS - S1 S2+
  • 7. LABORATORY EXAMINATION Tests Performed 20/12 23/12 26/12 28/12 Normal values Hemogram Hgb 4.2 4.2 4.9 6.0 F= 12.3-15.5 g/dL PCV 17 F = 36-45% RBC 2.6 2.4 F = 3.5 – 4.5 × 10⁵ / mm³ Platelets 21000 5000 4000 1000 1.5-4.5 lakhs/mm³ MCH 18 19 27-32 pg / cell MCV 75 72 80-96 fL MCHC 22 24 33 – 35.5 g/dL ESR 110 110 F= 1-20 mm /hr WBC 3920 3900 3990 4201 4000-11000/mm³ Neutrophils 64 63 59 62 45-73% Eosinophils 02 1 02 01 0-4% Lymphocytes 29 27 24 31 20-40% Basophils 00 00 00 00 0-1 % Monocytes 9 7 4 3 2-8%
  • 8. Tests Performed 20/12 23/12 26/12 28/12 Normal values VitB12 183 180- 914 pg/ml Ferritin 10 F= 11-307 ng/ml Sr.Iron 35 F= 37- 145 microgram / dL Transferrin 310 200 – 300 mg/dL Transferrin Saturation 18 20-50% Reticulocyte count 3.0 0.5 – 2.5 % UIBC 115 112-346 microgram/dL TIBC 252 250-450 microgram/dL Lipid Profile : HDL 24 > 65 mg/dl RFT S. creatinine 0.5 0.5 0.4 F= 0.5-0.9 mg/dL BUN 10 10 10 7-20 mg/dl Sr. Sodium 140 140 139 136-145 mEq/L Sr .Potassium 4.4 3.8 3.8 3.5 – 5.1 mEq/L Sr. Chloride 112 111 105 97-114 mEq/L
  • 9. Tests Performed 20/12 23/12 26/12 28/12 Normal values LFT Albumin 4.4 4.8 3.5-5.5g/dL Globulin 3.0 2.7 2.5-4.5 g/dL ALP 126 119 30-120 unit/L SGOT/AST 21 21 10-35 U/L SGPT /ALT 11 10 <35 U/L T. Bilirubin 0.6 0.7 Up to 1.2 mg/L Sr. Direct bilirubin 0.6 0.5 0.2 mg/dL GGT 42 44 1-94 U/L PT 12.4 11.1 – 13.1 sec S . Total protein 6.9 6.6 – 8.7 g/dl INR 0.91 0.9-1.1 Biochemistry LDH 256 265 F = 135 – 214 U/L ANA +
  • 10. Impression : Severe microcytic hypochromic iron deficiency anemia with leukopenia & severe thrombocytopenia.
  • 11. FINAL DIAGNOSIS • Patient is diagnosed with Systemic lupus erythematosus ( non renal).
  • 12. TREATMENT GOALS • Patient specific – -Improve QOL -Selecting cost effective medicine & minimizing side effects of medicines • Disease specific – - Control the acute symptom of SLE & protect organs by decreasing inflammation - Decreasing autoimmune activity in body - Bringing the abnormal blood parameters to normal
  • 13. TREATMENT CHART • Medicine • prescribed • Generic name • Dose • Freq • Route • Indications • Start date • Stop date Medicine prescribed Dose Freq Route 20 21 22 23 24 25 26 27 28 29 30 31 T. HCQ HYDROXYCHL OROQUINE 200mg 1-0-1 P/O + + + T. MYCOPHEN OLATE MOFETIL 500mg 1-0-1 29 (1-1-1) ’’ + + + + + Inj. METHYLPRE DNISOLONE 1g in 100 ml NS 1-0-0 IV + + T. Wysolone PREDNISOLON E 30mg OD PO + + + + + + + + + T. Fe + FA FERROUS SULPHATE + FOLIC ACID 200mg /5mg 1-0-1 p/o + + + + + + + + + + + + T. PCT ACETAMINOP HEN 500mg 1-1-1 P/O + + Zytee Gel CHOLINE SALICYLATE 1 FTU 1-1-1 Topical + + + + + + + + + + + +
  • 14. Medicine prescribed Generic name Dose Freq Route 27 28 29 30 31 Inj. Optineuron Cyanocobalamin (B12), D- Panthenol (Vit B5), Pyridoxine (Vit B6), Riboflavin (Vit B2), Thiamine(vit B1), Nicotinamide (vit B3) 1 amp in 100 ml NS B1-100mg B2 -5mg B3- 100mg B5- 50mg B6-100mg B12- 1000mcg OD IV + + + + +
  • 15. PROGRESS CHART Date BP (mmHg) Pulse (Beats/min) SPO2 % Complaints Notes 21/12/19 100/70 80 97 Rashes over limbs CVS: S1S2 + , CNS : HMF + , PA : soft NT , RS : B/L NVBS + 22/12/19 110/70 82 95 ’’ 23/12/19 100/80 80 Fever , headache ’’ Temp: 38° C ( Febrile) 24/12/19 110/70 80 97 ’’ 25/12/19 110/70 83 98 ’’ 28/12/19 100/70 81 98 Fever ’’ Temp : 38° C 31/12/19 100/70 79 98 ’’
  • 16. CLINICAL PHARMACIST NOTES / INTERVENTION • Drug – drug interactions : • Drug – food interactions : • Advice to Physician : Since patient is on steroid therapy which may cause Osteoporosis so shall we include CALCIUM & VITAMIN D supplement in the prescription RANGE INTERACTIONS REASON Major Ferrous sulphate + Mycophenolate Ferrous sulphate ↓ effect of mycophenolate by inhibiting GI absorption Major HCQ + Mycophenolate Both ↑ immunosuppressive effects RANGE INTERACTIONS REASON Moderate HCQ + Grape fruit Grape fruit ↑ blood level of HCQ causing irregular heart beat
  • 17. DISCHARGE MEDICATION Medicine prescribed Generic name Dose / Route Frequency/ Duration Possible side effects T. MYCOPHENOLATE MOFETIL 500mg P/o 1-1-1 × 1 month Headache , fever, abd pain T. HCQ HYDROXYCHLOROQUIN E 200mg P/O 1-0-1 × 1 month Nausea , taste disturbance T.PCT PARACETAMOL ( ACETAMINOPHEN) 500mg p.r.n × 1 week stomach pain , ulcer in mouth T. Fe + FA FERROUS SULPHATE + FOLIC ACID 200mg + 5mg 1-0-1 × 30 days constipation/ loose motion , dark color stool
  • 18. PATIENT COUNSELLING • Disease • Medication • Diet • Lifestyle modification