40yr old with severe anemia
A 40 yr old female came to hospital with chief complaint of Menorrhagia past 6months
HISTORY OF PRESENT ILLNESS:
A 40yr old female who was born out of consaginous marriage grade III through a normal vaginal delivery at her mother's sister house. She immediately cried and was breast fed for 1year.
Her immunization is not known .
Since childhood she used to eat only one meal per day though she had a good appetite because of weakness.
She used to sway side by side while walking,sometimes fell down and again she used to get up on her own.
She used to get ready to school by herself.(wearing uniform,combing hair)
She used to repeat her standard almost 2-3 times.
She attained menarche at the age of 14yrs with normal flow 4-5 days/month with no clots. LMP- 5/2/2022
Once she complained of heavy bleeding for a month for which they went to local mbbs doctor who provided medications and her bleeding was relieved.
Now since 6 months ,she is having heavy bleeding per vagina during her cycles with clots for which they took medication which was prescribed earlier which was not relieved.
Then they went to local hospital where she was diagnosed as anemic and blood transfusion was suggested. But transfusion wasn't done due to unknown reasons.
Then she came to our hospital.
PEDIGREE CHART
PAST HISTORY:
Not a k/c/C/o DM, HTN, thyroid, epilepsy, asthma.
General examination
Patient is c/c/c thin built and malnourished
Pallor ++,
no icterus, cyanosis, clubbing, edema
Temp-Afebrile
PR - 108bpm
BP-100/60 mmHg
Spo2 99%
GRBS - 87mg/dl
CVS
Inspection -
JVP raised
Apical impulse diffuse in 5th and 6th IC space
Palpation - thrills and para sternal haeve +
apex beat in mud clavicular line
Auscultation - loud S1 S2 + at pulmonary and tricuspid area , systolic murmer +
CNS Examination
PT - c/c non Co operative
MMSE 20/30
Speech normal
Cranial Nerve examination:
CN 1 Not done
CN 2 Normal pupillary reflex
CN 3, 4, 6 Upward and lateral eye movement restricted ( She was closing eyes)
CN 5 Weak
CN 7 Weak
CN 8,9,10,11,12 Not done as she was not co operative
Sensory examination Not done as uncooperative
Motor system
Tone - Rt Lt
U/L N N
L/L N N
Power
U/L 4/5 _ 4/5
L/L 4/5 _ 4/5
Reflex
Biceps 3+ 3+
Triceps 3+ 3+
Supinator 3+ 3+
Knee 3+ 3+
Ankle 3+ 3+
Plantar dorsiflexion
Romberg test:
https://youtu.be/YwIbnvArBlI
RS - BAE +
P/A - soft NON-TENDER
Her outside reports were :
HB- 2.3%
Plt - 56,000
TLC - 7900
PCv - 8.2%
BGT - O +ve
Sr.cretinine- 1.4 mg/dl
Na+ - 139
CL - 96
K- 2.9
LFT
TB - 1mg/dl
DB - 0.2,ID - 0.8
ALT - 27, AST - 28
ALP - 114
TP - 6.9
ALB - 3.3
GLB - 3.6
Investigations on 07/02/2022
ECG
ECG ON 08/02/2022
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