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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question Category : Anemia
Dear Doctor, 8 year old child shows pallor and short stature. His history and exam is normal. Apart from this point,at the age of 2 months he was operated for pyloric stenosis. The surgeon made a mistake, he injured the mucosa, he sutured it and did a jejeno-gastrotomy which is not done basically. Does this explain the anemia and short stature..? If yes ...how? Check Out the Answer
Question Category : Anemia
Sir/Madam, My child was suffering from initial stages of pneumonia and also stools after every feed. He was medicated for 2 weeks. Altacef, nutrolin-B, Cheston, Levolin were the medicines given to him for 10 days. Along with this he was taken for nebulizer. Fever was on and off, so blood test was done. The results are given below. Now the problem is that his appetite is very low. His weight is only 6 kg at his 8th month. He seems to be very lean and small but is very much active. He again got a mild cough and cold. Please suggest me a way to prevent and protect him from cough and cold. How can he get rid of it. How can I increase his appetite. (During medications he ate for every 4 hours). Child's Name : Gokul Age : 8 months. Birth weight : 2.52 kg. Now he weighs : 6 kgs. Child is active. Stools passed twice a day. Sits by himself. Tries to stand. Food given: rice, nestum, geeth powder, mother's milk, smashed apple. Blood test report : Total WBC Count : 7,700 Cells/cu mm, Differential Count Neutrophils : 50% Lymphocytes : 43% Eosinophils : 07% Monocytes : 00% Basophils : 00% Erythrocyte sedimentation rate At 30 mts : 25 mm At 60 mts : 60 mm Grouping : 'B' RH : Positive Hemoglobin : 10.1 G/dl P.C.V : 33% R.B.C Count : 3.36 millions/cu mm M.P & M.F[Q.B.C Method] : Negative. S.G.P.T : 14 IU/ml ------------------------------------------ Blood Smear Study: Hypochormic : normocytic erythrocytes normal leukocytes with lymphocytosis and eosinophilic. thrombocytes : adequate in number. blood parasites : nil abnormal cells : nil immature cells : nil ----------------------- Stools test: Nature of specimen : FAECES Macroscopic Color : Brownish yellow consistency : semi solid mucus : nil frand blood : nil parasites : nil MICROSCOPIC Protozoa : nil cysts : nil Ova : nil RBC : nil Pus Cells : nil Vegetable cells : + Crystals : nil Chemical Reaction : -- Reducing substance : +++ Occult blood : -- Urine Culture : No growth. These above test were taken on 17-11-2006. Check Out the Answer
Question Category : Anemia
An 18 year old boy born from non consanguineous marraige, presented as chronic anemia was under evaluation since 2000. He showed fatigability, paleness of body, intermittent abdominal pain, swelling over body [diagnosed as iron deficiency anemia]. He was positive for occult blood in stool repeatedly,. He was further investigated by colonoscopy, USG and RBC labelled GI bleed scan which were normal. A urine routine examination was normal. Hb electrophoresis was normal. A CT enteroclysis reveled jejunal wall thickening and jejunal polyp. But there was no H/O frank blood in stools, no H/O recurrent enteritis., O/E marked pallor, mallor, erythemaus rashes on the face, mild hepato splenomegaly, no rash on the body, no LNpathy, no arthritis. A younger sister of patient is also having anemia and abdominal pain intermittently but not investigated. So what could be the final diagnosis? Check Out the Answer
Question Category : Anemia
A 30 day old newborn, had Rh incompatibility. Rh positive mother had Hb 8 gm, normocytic normochromic anemia. The baby was given iron drops instead of blood transfusion. After 15 days ,Hb level increased only by half gm. Why didnt he respond to iron drops? What should be line of treatment? Should iron drops be continued or the baby should be given blood? Check Out the Answer
Question Category : Anemia
In G-6-PD Can we find and why? Because it is considered as hemolytic anemia hence why no splenomegally???? Check Out the Answer
Question Category : Anemia
The platelets count is low in an aplastic anemia patient and she is bleeding from a wound secondary to thrombocytopenia.. She is cant afford and we cannot mobilize platelets for her, as they are not available in our hospital or any where outside. What drugs can be used to stop or reduce the bleeding in this case? Atleast temporarily for sometime. Check Out the Answer
Question Category : Anemia
A 4 years old female presented with sudden attack of fever, loose motion. No F\H of favism, or blood transfusion. The O\E: GC is good. She also has striking pallor, no icterus, no hepatosplenomegaly, no significant lymphglands. The lab.values: HBg 6g%, Ret.count 10% , normocytic hypochromic blood picture, normal platelet count, no hemoglobinuria ,no blood in the stool. Can you give some further suggestions to reach diagnosis? Check Out the Answer
Question Category : Anemia
An anemic child aged 1 year 6 months has oral intolerance. She gets diarrhea, as soon as iron drops are given. Which preparation are most suited to such babies? What should be the solution to this problem? Is it appropriate age for Hb electrophoresis? Check Out the Answer
Question Category : Anemia
I would like to know how can I manage a case of autoimmune haemolytic anemia (agglutinin cold antibodies)? The patient is one year old, her hemoglobin is 7 gm%, her blood group is AB+ which isn`t compatible with the same blood groups in our bank. Check Out the Answer
Question Category : Anemia
A female child few years old with chronic pallor for 2 years, needed blood transfusion 4 times previously. No fever , hepatosplenomegaly or lymphadenopathy is seen. Investigations: HB : 5.5 gm/dl, RBCs : 2500000, platelets : 120000/cc, wbcs : 11000, hb electrophoresis : Hb A1. Check Out the Answer
Question Category : Anemia
A 4 year-old boy, known to have Chronic Granulomatous Disease, is on Co-trimoxazole prophylaxis. He was admitted 3 weeks ago with herpetic stomatitis, secondary to HSV type I. During admission the child was febrile, and had petechial lesions & herpetic stomatitis. No lymphadenopathy & no hepatosplenomegaly was seen. His CBC showed Pancytopenia (WBC 1700, absolute neutrophil count 260, RBC 2.6, hemoglobin 7, platelets 20,000). Retcis 5.4% .Peripheral blood film showed slight spherocytes, target cells, shistiocytes and mild hypochromia. Renal function test, liver function test & coaggulation profile were normal. He was given a course of Ceftazidim, Cloxacillin (for 10 days) & Acyclovir IV for 4 days. His herpetic stomatitis resolved, fever subsided, and blood culture had no growth. The possibility of viral or drug-related bone marrow suppression was the initial impression, but being an immunodeficient host, through our knowledge CGD is not associated with leukemias, and with a ? Family history of leukemia, malignancy had to be ruled out. Bone marrow aspiration showed hypercellular marrow with no abnormal cells. So the investigations were directed to possible autoimmune process with Evans syndrome. Direct Coombs' tests done twice were negative. ANA and anti-platelet antibodies were negative. Other investigations showed a total bilirubin 23 umol/L, direct 4. Haptoglobin <0.06 g/L (NR 1-2.3), serum ferritin 179.9 (NR 30-400), triglyceride 1.32. Ham test weakly positive. Urine analysis was normal. The patient was given 2 doses of IV immunoglobulin but the pancytopenia persisted. He was given GC-SF, and the neutropenia responded. He also received Prednisolone 2 mg/kg/day for 6 days but he showed no response regarding the platelet count, and so it was discontinued. His CBC after this 3 weeks period showed WBC 5940, ANC 2140, RBC 1.61, hemoglobin 5.1, platelet 13,000, retics 32.4 % . His general condition remains stable & afebrile, with no new findings on his physical examination. What is your impression? Your suggestions are welcome to best_pedia@yahoo.com . Thanks for your time and for helping this child. Check Out the Answer

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