IRON DEFICIENCY ANEMIA HEPATOSPLEENOMEGAlY+DELAYED PUBERTY (absence of thelarche by 13 y) Growth retardation ? SECONDARY TO NUTRITIONAL CAUSE

AMC case 

17/F 

patient came with chief complaints of sob  on exertion since 2 months 
HISTORY OF PRESENT ILLNESS :- 
patient was apparently asymptomatic  2 months ago then she developed  sob on exertion  grade 2. she went to get covid vaccine  2 days back  and when she got blood investigations she got hemoglobin 2.3 
she complaints of chest pain  on and off  since 2 months 
she complains of generalized weakness 
c/o palpitations since 2 months 
no meleana / hemorroidhs 
no past h/0 surgeries 
she attained menarche  6 months ago 
3-5 /30 , 2-3 pads/day fully soaked 

one unit of prbs was done on the day of admission 
One unit of prbs was given on 2/3/22

no pain , no clots 
PAST HISTORY :- 
no  past h/0 of blood transfusion 
N/k/c/o asthma , htn, dm , epilepsy 

on examination :- 
patient was conscious , coherent , co operative 
pallor   present
cyanosis, icterus , lymphadenopathy, edema , are absent 

vitals :- 
temp 97.3F
PR. 98 bpm
bp 110/50 mm hg
RR.  16cpm
spo2   99%

systemic examination:- 

CVS . s1 , s2 heard 
RS.   bilateral air present 
P/A.  soft non tender 
Mild hepatomegaly , splenomegaly
CNS. Intact 
            gcs 15/15 
           motor system   intact 
           sensory system  intact 
           reflexes.     normal 

INVESTIGATIONS :- 
HB :2.3 
TLC 3,400
PLT. 1.70 
anisopoikilocytosis with microcytic hypochromic , tear  drop , 
BGT.  B positive 
reticulocyte count. 1  %

28/2/22
ESR. 20 
LFT :- 
TB. O.98 
DB 0.24 
SGOT   26 
SGPT.    17 
ALP  201 
TP  7.4 
ALBUMIN  4.5 
A/G RATIO. 1.54 

RFT 
SR UREA. 1.6 
SR.  CREATINE 0.5 
URIC ACID. 2.3 
NA+. 140 
K+. 4.0 
CL-  102 
SR FE.  50 
1 /3/22 
hb 5.1 g/dl 
tlc.  2500/mm3 
plt.  1.5 lakhs /mm3 




4/3/22
HB 7.2



Hemogram on day of discharge
bone marrow report



AMC bed-6
7th day of admission
 
S: no complaints 
O:  O/E pt is c/c/c 
Vitals: PR-104bpm
            BP-110/70 mm Hg 
            CVS- s1s2 +
            RS- BAE+ 
                           Pt.           Normal 
Menarche          16yr       12-14y
Pubarche +       16y          12-14
Thelarche +       15y           11-11.5y
Axillary hair        Absent
Wt: 33.5kg
Ht: 151cm


A: IRON DEFICIENCY ANEMIA HEPATOSPLEENOMEGALY+
DELAYED PUBERTY (absence of thelarche by 13 y) 
? SECONDARY TO NUTRITIONAL CAUSE

P: 
Inj NERVIGEN 1amp in 100ml NS IV OD
T. OROFER PO OD
T. NEUROBION FOR PO/OD
T. ZINCOVIT 

TOTAL IRON DEFICIT 826mg
INJ IRON SUCROSE 200 mg in 100 ml NS over 1 hr






provisional diagnosis :- 
IRON DEFICIENCY ANEMIA


TREATMENT 
1) INJ NERVIGEN 1AMP IN 100 ML NS IV OD
2) TAB OROFER XT PO OD 
3) TAB MATIDA FORTE PO OD

http://vjeevanreddy179.blogspot.com/2022/02/iron-deficiency-anemia.html

AMC bed-6
9th day of admission
 
S: no complaints 

O:  O/E pt is c/c/c 
Vitals: PR-100 bpm
            BP-100/80 mm Hg 
            CVS- s1s2 +
            RS- BAE+ 

                           Pt.           Normal 
Menarche          16yr       12-14y
Pubarche +       16y          12-14
Thelarche +       15y           11-11.5y
Axillary hair        Absent
Wt: 33.5kg
Ht: 151cm


A: IRON DEFICIENCY ANEMIA HEPATOSPLEENOMEGAlY+
DELAYED PUBERTY (absence of thelarche by 13 y) 
Growth retardation 
? SECONDARY TO NUTRITIONAL CAUSE

P: 
-Inj NERVIGEN 1amp in 100ml NS IV OD
- T. OROFER PO OD
- T. ZINCOVIT PO OD 

- INJ IRON SUCROSE 200 mg in 100 ml NS over 1 hr
- Planning to discharge today

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