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Pediatric Oncall Journal

11 year old with fever, pallor and ecchymosis

11 year old with fever, pallor and ecchymosis

Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai.

Medical Sciences Department, Pediatric Oncall, Mumbai
Clinical Problem
Case report: 11 year old boy born of third degree consanguineous marriage presented with fever and increasing pallor since 15 days. There is no history of bleeding, jaundice, high coloured urine, bone pains, rash or drug ingestion. On examination, he had tachycardia (heart rate = 118/min) with pallor and ecchymosis over the IV site. There was no lymphadenopathy or organomegaly. Other systemic examination was normal. He was treated with blood transfusion for the failure and anemia.

What is the diagnosis ?
Expert's opinion: Dr Ira Shah

This child has come with sudden onset pallor that has led to cardiac failure. Thus, the anemia is of acute onset and may be due to blood loss, hemolysis or sudden bone marrow arrest as in aplastic anemia or leukemia. Nutritional anemia or anemia of chronic duration is usually long standing and compensated and rarely leads to failure. This child’s pallor was noticed to increase in last 15 days and thus it is unlikely to be anemia of chronic illness or nutritional anemia. The child does not have any finding suggestive of sudden bleeding and also there is no hemoglobinuria or jaundice to suggest acute hemolysis. Hence, the anemia may be most likely of bone marrow involvement. Since the child also has fever and ecchymosis over the IV site, one could consider 3 cell line affection. Leukemia would have led to other features such as organomegaly or lymphadenopathy which the child does not have. Hence, the most likely diagnosis in this child would be aplastic anemia.
The child’s hemogram showed hemoglobin to be 2.7 gm% with white cell count of 2,700/cumm and platelet count of 20,000/cumm with reticulocyte count of 0.3% suggestive of pancytopenia with bone marrow involvement. Bone marrow aspiration and biopsy showed hypocellular marrow confirming diagnosis of aplastic anemia.
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None
Cite this article as:
Shah I. 11 year old with fever, pallor and ecchymosis. Pediatr Oncall J. 2007;4: 36.
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