1. -fatigue for 20 days

2. 25year old Pakistani male,Not known to have any chronic illness before, referred from Alkhurma Hospital. Pt. presented there complaining of fatigue for 20 days with mild exertion all the day time interfering with daily usual activity associated with dizziness and subjective fever He also give history of gum bleeding, small amount while brushing his teeth last 5 days. He went to alkourma hospital did some investigatin and refered due to abnormal result.

3.  No Hx of nausea, anorexia, night sweating or wight loss  NO Hx of hematmesis, hemoptesis or bleeding from other orifices.  No Hx of polyurea or polydepsia  No Hx of wight gain, cold intolrance or change in bowel habit.  No Hx of raw milk ingestion

4. CVS CVS : NO chest pain, palpitation, SOB, cough, syncopal attack, lower limb swelling. RS RS : no hemoptysis or runny Nose Musculoskeletal: Musculoskeletal: NO joint pain, muscle pain or skin rash. abdomen : abdomen : no abdomenal pain, No jundice. CNS: CNS: no headach,neck pain, focal weakness or convulsion

7. He work as floorer He is single Non smoker or alcholic No Hx of sexual contact Came from Pakistan 6 months ago

9. - abdomin : soft, lax not distended not tender no ascites no organomegaly no mass pallpable PR = NO melena. No stigmata of chronic liver disease

11. summery 25year old Pakistani male,Not known to have any chronic illness before, referred from Alkhurma Hospital c/o fatigue for 20 days with mild exertion with dizziness and subjective fever He also give history of gum bleeding. On examinatin pale

15. Chest x ray : unremarkble

16. - Acute Viral infection -Folate and B12 deficiency -Primry or secondry bone marrow failure - connective tissue disease (like SLE) -Chronic non viral infecion (like brucellosis, TB ) -Medicaions ( like NSIAD)

17. Patient admitted in male medical word with following order:

18. Admit the pt in male ward as case of Pancytopenia for investigation V/S EVERY 6 HR STANDLY 2 UNIT PACKED RBC AFTER CROSS matching -abdominal US

19. -CBC with diff. CBC daily, chemistry, -Blood film for review -Iron profile folic acid and B12 -Retic count -Stool for occult blood -Hepatitis profile,HIV, Brucella, widal -Urine analysis -Coombs test -Septic screen.

20. -Malaria film -ESR -CRP -ANA

21. Start Paracetamole 1gm prn.

33. Because of low vit B12 the patient started on methylcobalamine injection 1000 mic IM OD

35. -Pt receive 1 unit PRBCs - The patient still admitted in mmw waiting for result rest investigation