PANCYTOPENIA CASE

 55 year old female came to hospital with complaints of  fever since 3 days , leg pain since 3 days 
HOPI: 
Patient was apparently asymptomatic 3 days back ,Then developed fever which is insidious in onset, gradually progressive , low grade ,continuous, with no chills and rigors .
Leg pain since 3 days in both lower limbs associated with tingling and numbness 
H/o pain in hypogastric region , non radiating and associated with burning micturation 
H/o breathlessness grade 2-3 MMRC aggregated on exertion,  relieved on rest .
No H/O chest pain, palpitations , orthopnea , syncope , PND .
No H/O Vomitings , loose stools , cough and cold.
No H/O Hematuria, bleeding gums, dark coloured stools , petechiae ,purpura.
PAST HISTORY:
Not a K/C/O  T2DM, HTN,CVA, CAD, Thyroid , Seizure disorder, Asthma ,TB
PERSONAL HISTORY: 
Diet- mixed ,Normal apetite , bowel habits regular ,Burning micturation present.
No known  allergies and no addictions.
MENSTRUAL HISTORY:
Attained menopause 6 years back
PHYSICAL EXAMINATION: 
Pallor -present
No Icterus,  Cyanosis, Clubbing ,lymphadenopathy 
VITALS: 
Temp: 96.3 
PR: 76bpm
RR: 18cpm
BP: 90/60mmHg 
Grbs: 128mg

CVS: S1S2 heard , no thrills, no murmurs
RS: Dysnea present , No wheeze , NVBS: heard
Per Abdomen: Obese, non tender, no palpable mass, no organomegaly.
CNS: conscious,normal speech 
Cranial nerves normal
Motor and sensory system normal
E4V5M6
REFLEXES: Rt     Lt 
 Biceps  : 2+        2+
Triceps :  2+.        2+ 
Supinator : 1+      1+ 
Knee:        2+.        2+
Ankle:        1+         1+ 

INVESTIGATION:USG
ECG: 
Hemogram:
Chest xray :

Cue:

              
Provisional diagnosis: PANCYTOPENIA UNDER EVALUATION 
Treatment:
1.Iv fluids NS @ 30ml /hr
2. Inj CEFTRIAXONE 1gm IV BD
3. Inj OPTINEURON 1amp in 100 ml NS IV OD
4. Inj PAN  40mg IV OD
5. Tab PCM 650 mg po /TID
6. Monitor vitals and inform sos
7. Inj SUCROSE 200Mg in 100 ml NS IV on alternate day
8. Inj VITLOFOL 1000mcg IM OD
9. Strict I/0 Charting



 










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