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PRESENTATION By DR. Ramesh Bhargava

. Mr. R aged 17 yrs, Male admitted to my HOSPITAL ON 3/08/2008 with H/O High Grade Fever, Vomiting, Loose Motions

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PRESENTATION By DR. Ramesh Bhargava

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    1. PRESENTATION By DR. Ramesh Bhargava

    2.

    3. ON INVESTIGATION 1.CBP- Hb 6 gm % TWBC- 11,200 P- 64% L- 30% M- 3% E- 3% 2. Urine Routine & Microscopic test - NAD 3. PS FOR MP- NEGATIVE 4. X- Ray Chest NAD 5. Blood Widal -VE 6.Blood Glucose R-98 mg % 7. S. Bilirubin 6.00 mg % SGOT -70 SGPT -60 Hbs Ag- NEGATIVE 8. Blood Urea 30 mg % S. Creatinine 1.4 mg % 9. Widal ve 10. Ultra Sonography shows Hepatosplenomegaly 11.Echo- NAD

    4. X- RAY [ NAD ]

    5. TREATMENT GIVEN Blood Transfusion II Inj Arteethar 150 mg daily for three days Inj Cefotaxim 1 gm bd Inj metrogyl 500 mg 8 hourly Symptomatic & Supportive Treatment He responded to treatment & became afebrile on 3rd day remained in the hospital for 10 days, recovered and then discharged.

    6. On 4/10/2008 he again admitted to private Hospital with H/O Fever, Vomiting where he was again investigated 1. CBP Hb 8 gm % TWBC 9,300 P- 70% L- 20% M- 3% E- 3% B- 4% 2. PS for MP -ve 3. Urine Routine Microscopic Test / NAD 4. X- Chest NAD 5. S. Bilirubin 3.0 mg % SGOT & SGPT 30 40 6. Reticulocyte count 3% 7. G6PD deff Not Detected 8. Sickling Test- -ve 9. Coombs Test- -ve 10. Hb Electrophoresis (N) 11. USG-Hepatosplenomegaly 12. ECG Within normal limit ( WNL)

    7. TREATMENT GIVEN IV Ceftrixone 1 gm bd .. IV GM 80 mg IV bd.. IV Artesunate 120 gm IV Stat than 60 mg IV daily for Four Day Remained in the Hospital for 5 days than discharged

    8. Again he came to my clinic on 16/12/08 with H/O Fever, vomiting O/E Hb 4.0 gm % TWBC -2800 P- 50% L- 47% M- 02 E- 01 PS- MP -VE S. Bilirubin 3.6 mg %

    9. Bone Marrow Examination CELLULARITY- Hypercellular M: E Ratio:- 1:3 (reversal) ERYTHROPOISIS: Show marked erythrorid hyperplasia with many precursors and few macronormoblasts with feature of dyserythropoisis few trophozoits and schizoni of P. Vivax seen. LYMPHOPOISIS :- Shows mild increase in lymphocytes.. MEGAKARYOCYTES:- Normal in number but functioning IMPRESION :- Macronormoblastic erythrorid hyperplasia secondary to P.Vivax

    10. Blood Transfusion II INJ chloroquine TAB- Primaquine Symptomatic & supportive

    15. THANK YOU

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