Major case presentation Dimorphic anemia

SCENARIO: Here is a 35years old female patient admitted in medicine female ward diagnosed as dimorphic anemia was hospitalized for 6 days. CHIEF COMPLAINTS: c/o breathlessness since 15 days c/o giddiness since 15 days HISTORY OF PRESENT ILLNESS: Patient was apparently alright 15 days back then she developed breathlessness, insidious in onset and progressive. Patient also complains of giddiness even at rest gradually progressive. PAST MEDICAL HISTORY: Patient is a k/c/o anemia blood transfusion was done when she delivered second child

LABORATORY INVESTIGATION: Peripheral smear report: Dimorphic anemia with leucopoenia with mild thrombocytopenia Test Patient value Normal value WBC 4500 cumm 4000-11000 cumm RBC 1.12 million/μl 4.0-5.5 million/μl Hb 4.5 g/dl 11-14g/dl PCV 12.3 % 35-46% MCV 109.8 fl 80-100fl MCHC 36.6 g/dl 32-36 g/dl MCH 40.2 g/dl ESR 70 mm/hr <20 mm/hr MPV 13.0 fl 7.4-11.4 fl PDW 15.7 fl 10-14 fl Platelet count 1.50 1-3 lakhcell/cumm

General physical examination: Pallor + SOAP NOTE: Subjective: Here is a 35 years old female presenting complaints of breathlessness and giddiness since 15 days. Objective: RBC is decreased that indicates anemia. Hb is drastically decreased which indicates severe anemia ESR is increased due to infection PCV is decreased that indicates over hydration or due to anemia or blood loss.

MCV & MCH values are increased which indicates macrocytic & hyperchromia. RDW (RBC distribution width)the normal values are found in anemia. MPV (mean platelet vol ) is increased it indicates there is destruction of platelets. (Alloimmune thrombocytopenia - eg, neonatal, post-transfusion) PDW (platelet distribution width) is increased it indicates high PDW means that platelet size varies greatly, a sign of active platelet release. Peripheral smear shows that dimorphic anemia with leucopeonia with mild thrombocytopenia. Diagnosis:by observing the above subjective and objective data the patient is diagnosed with dimorphic anemia.

ASSESSMENT: Problem list: 1.Breathlessness 2.Giddiness 3.Dimorphic anemia -Breathlessness: It is due to anemia the oxygen carrying capacity is decreased. -Giddiness: It is due to anemia Dimorphic anemia : is a dual population of RBCs in the peripheral blood smear with both microcytic hypochromic and normocytic macrocytic red blood cells which is a typical finding of iron deficiency vitamin B12/folic acid deficiency anemia.

PLAN OF CARE: Goals of therapy: To alleviate signs and symptoms Correcting the underlying etiology Prevent reoccurence of anemia.

S.no Brand name Generic name Dose & freuency Day 1 2 3 4 5 6 1. IVF dextrose 500ml Y 2. O2 inhalation 3. Inj.Bactocef iv Cefuroxime 1gm 1-0-1 4. Inj.Pantox iv Pantoprazole 40mg 1-0-0 5. Inj.P-cet iv Ondansetron 1amp 1-1-1 6. Syp.Hemowin Oral iron supplement 2tsp 0-0-1 7. Inj.Vitcofol im Folic acid 2cc 0-1-0 8. Cap.Fesovit FA+nico+B6+B12 + Feso4

Drug-drug interactions: Cefuroxime + pantoprazole - decreases the absorption of cefuroxime Monitor CBC for the normal levels RBC,Hb Patient counselling: Patient is advised to take iron rich diet such as green leafy vegetables, fruits, egg, liver, kidney etc, Discharge drugs: 1.syp.Hemowin 2tsp -0-0-1 x 10 days 2. cap. Fesovit 0-1-0 x 30 days 3. Inj. Vitcofol 2cc im 0-1-0 alternate days for 1 wk.

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