Hematology - Hematological problems
Under Category :  Hematological problems
Posted By :  Dr.  SUNDEEP NIGAM
Posted On : 9/22/2013 3:59 AM
splenomegaly with pancytopenia with fever ?
a 7 yrs old girl having high grade fever for 7 days , mod splenomegaly present, usg shows mild ascitis, hb 7, tlc 2500, platlet 35000,mp, widal negative.what could be the d, d
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Few more details needed here
Is there any rash,joint involvement ,muscle pain ..jaundice. lymph node..and the vitals
Out of the three categories of possibilities.. Infection likely to be possibility by 85 percent chance. connective tissue disorder 14 percent and malignancy 1 percent... I ll start the dissection from the last.
Why malignancy is least likely .. a, short duration , b. No pallor lymph node mentioned.. and free fluid in peritoneum is least likely { this argues for inflamation of peritoneum, portal pressure, hypoalbuminemia , None of these are common in malignancy
Why chance of connective tissue disorder less. ...........Of course long fever. , ascitis and low count of leucocyte and platelets one possibility to be considered is SLE..But not much points to support ,, 7years a bit un usual . We ll keep that possibility in mind , if other causes ruled out and fever persists. Here CRP, ESR should have been mentioned
Of course the main possibility is infection .. Out of the infections two major ones.in the context of low counts..1. Typhoid 2. Dengue..
In this case most likely dengue....
Typhoid is a bit unusual to have this low platelet....still it is better to repeat widal and do culture.
Other infections like tuberculosis and lepto are less likely to lead to this low count even though clinical possibilty to be entertained..
Always better to take a peripheral smear as the spleen is a bit larger.. But the abscence of pallor makes malaria a bit unusual ..
10/27/2013 9:47:22 AM

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