45/f DiagnosisDimorphic anaemia (Iron and Vit B12 deficinecy) with AUB (Fibroid uterus)

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Case History and Clinical Findings

A 45 year old female who is a resident of miryalaguda has come to the casualty with the chief complaints ofIncreased bleeding per vaginum since 5 daysSOB since 5 daysPalpitations since 5 daysPain abdomen since 5 days

History of Presenting illness:

Patient was apparently asymptomatic 5 days ago then she had her menstrual cycle started which was associated with increased bleeding per vaginum for 3 days during the cycleon first 2 days she changed 10-12 pads per day from then 1-2 pads per dayBNo h/o bleeding manifestations from other sitesWith the increased bleeding per vaginum she also developed shortness of breath which is Grade 2 Orthopnea PND Palpitations + It was associated with Pain abdomen which is insidious in onset and gradually progressive (Site?)

No h/o burning micturition No h/o any white discharge per vaginum No h/o pain radiating to other sites No c/o black coloured stools No history of chest painNo facial puffiness No history of decreased urine output

Past History:

No h/o similar complaints in the past

Known case of hypertension since 2 months and is not regular (Medication unknown)

Not a known case of DM, TB, Asthma, Epilepsy, CVA, CADNo history of any blood transfusions

No h/o any previous surgeries

No known allergies

Personal history:

Diet- Mixed Appetite- Good Bowel and bladder movements- Regular Sleep Adequate Addictions- None

Family history:No significant family history

No family history of Hypertension, Diabetes, TB, Asthma, Seizures

General Physical Examination:

Done after obtaining consent, in the presence of attendant with adequate exposure

Patient is conscious, coherent, cooperativewell oriented to time, place and person well nourished and moderately built

Pallor++ Icterus- Absent Cyanosis- Absent Clubbing- Absent Lymphadenopathy- Absent Edema Absent

Vitals Temperature- Afebrile Blood pressure- 120/80 mm of Hg Pulse rate- 78 bpm Respiratory rate- 18 cpm SpO2- 98% at room air

Systemic Examination:

Cardiovascular system:S1 and S2 sounds are heard No abnormal murmers

Respiratory system:Bilateral air entry is present Trachea is central Normal vesicular breath sounds are heard Dyspnoea is present No adventitious sounds are heard

Abdominal Examination:Shape of Abdomen is distended Soft and non tender Bowel sounds are heard No palpable mass Hernial orifices are normal No organomegaly

Central Nervous System:No focal neurological deficits

COURSE IN THE HOSPITAL

Patient was apparently asymptomatic 5 days ago then she had her menstrual cycle started which was associated with increased bleeding per vaginum for 3 days during the cycle SOB +PALPITATIONS  +she is a Known case of hypertension since 2 months and is not regular (Medication unknown)Basic investigations were done and her hemogram report was found to be Hemogram Hb- 4.9 TC- 8200 Neutrophils- 70 Lymphocytes- 25 Eosinophils- 0 Monocytes05 Basophils- 0 PCV- 17.1 MCV- 63.8 MCH- 18.3 MCHC- 28.7 RDW-CV- 19.3 RDW-SD- 45.1 RBC Count- 2.68 Platelet count- 5.44 Smear RBC- Microcytic hypochromic WBC- With in normal limits Platelets- Count increase on smear Hemoparasites- No hemoparasites seen ImpressionMicrocytic hypochromic anaemia with thrombocytosis Then OBG opinion was taken for which they advised T. PAUSE-MF /PO/BDand advised for USG and Thyroid profile After which 1 PRBC transfusion was done on 26/11/22 and then the hemogram report was found to be Hb- 7.1 TC8100 Neutrophils- 60 Lymphocytes- 22 Eosinophils- 6 Monocytes- 12 Basophils- 0 PCV- 23.7 MCV69.1 MCH- 20.7 MCHC- 30.0 RDW-CV- 22.4 RDW-SD- 55.6 RBC Count- 3.43 Platelet count5.06 Smear RBC- Anisopoikilocytosis microcytes pencil forms tear drops macrocytes and normocytes macroovalocytes with in normal limits WBC- With in normal limits Platelets- Adequate in number and distribution Hemoparasites- No hemoparasites seen Impression- Dimorphic anemia And again on 27/11/22, one more PRBC transfusion was done and then the hemogram report was found to be Hb7.7 TC- 16800 Neutrophils- 72 Lymphocytes- 15 Eosinophils- 5 Monocytes- 8 Basophils- 0 PCV25.6 MCV- 68.7 MCH- 21.2 MCHC- 30.8 RDW-CV- 24.0 RDW-SD- 56.5 RBC Count- 3.64  Platelet count- 5.13 SmearRBC- Anisopoikilocytosis with microcytes, normocytes, macrocytes and few pencil forms  WBC- Increased counts on smear Platelets- Increased counts on smear

No hemoparasites seen

Impression- Dimorphic anemia with thrombocytosis 

Investigation 1. ECG SINUS TACHYCARDIA 2. USG ABDOMEN MULTIPLE INTRA MURAL FIBROIDS LEFT ADNEXAL MASS 3. 2D ECHO TRIVIAL AR +: NO MR/TR NO RWMA, NO AS/MS GOOD LV SYSTOLIC FUNCTION DIASTOLIC DYSFUNCTION+

NO PAH/PE 

Treatment Given(Enter only Generic Name) 1. INJ. TRANEXAMIC 500 MG IV/SOS 2. INJ. VICTOFOL 1500 MCG/ IM/ OD 3. TAB LEVOGEN 150 MG/ PO/ OD 4. TAB. TELMA 20 MG/ PO/ OD 5. TAB. MVT PO/ OD 6. 2 PRBC TRANSFUSION DONE 

Advice at Discharge 1)INJ.VITCOFOL/IM FOR 4 DAYS FOLLOWED BY WEEKLY ONCE FOR 4 WEEKS FOLLOWED BY MONTHLY ONCE FOR 4 MONTHS 2)TAB.LEVOGEN 150 MG FOR 1 MONTH 3)TAB.TELMA 40 MG/PO/OD.

Follow up:. Limitation in physical activity

Diagnosis

Dimorphic anaemia (Iron and Vit B12 deficinecy) with AUB (Fibroid uterus) with left adnexal mass with K/C/O HTN since 2 months2 PRBC transfusion done