Maria Reyna- Xavier University Hospital Department of Pediatrics

Calang, Caryl Vin Feril, Jonhrey Sanchez, Irene

General: To present a case of aplastic anemia Specific: To identify and diagnose aplastic anemia based on clinical presentation To discuss differential diagnoses of aplastic anemia To discuss the epidemiology, etiology, pathophysiology, diagnosis, prognosis and treatment of aplastic anemia

A.P. 11 8/12 old Male Filipino Muslim Marantao, Lanao del Sur

Fever (Tmax 38C) Paracetamol (16.7mg/kg/dose)

Fever Body weakness Pallor Dizziness Anorexia

Fever Body weakness Pallor Dizziness Anorexia

Headache Nausea and vomiting Gum and lip bleeding Fast breathing

CBC and Blood typing Chest X-ray APL Na+ and K+ Urinalysis IgG and IgM TyphiDot

CBC and Blood TypingResult Reference Range

WBCRBC Hematocrit

3.1 1.2 11

4.50-13.50 x 109/L3.69-5.90 x 1012/L 35 45 %

HemoglobinPlatelet Count Neutrophils

3.4 26 54

11.50 25.50 gm/ L150 390 x 109/L 37 - 72%

LymphocytesMonocytes Blood Typing

424

20 50%8 - 14%

Type O Rh positive

ANC

1,674

Chest X-ray APL Chest X-ray Hazy densities at the retrocardiac area. Heart is normal in size. Trachea is at the midline. Diaphragm and costophrenic sulci are unremarkable. Bony thoracic cage appears intact. Impression

Blood ChemistryResult Reference Range

Na+

142.5

135 - 155 mg/dL

K+

4.22

3.5 - 5.3 mmol/L

Serology

IgG ang IgM TyphiDot Negative

UrinalysisResult Physical Examination Color Transparency Chemical Parameters Specific Gravity pH Sugar Protein Microscopy WBC RBC Epithelial Cells Reference Range

Yellow Clear

1.000 5.0 Negative Negative0 1/hpf 0 1/hpf Rare 0 2/hpf 0 2/hpf 0 2/hpf

Tranexamic Acid (8 mg/kg/dose) Vitamin K 1 amp IV Penicillin G IV drip (103,333 mg/kg/day)

Blood Transfusion 1 unit FWB (1st unit) CBC 6 hours post BT

CBCResult Reference Range

WBCRBC Hematocrit

2.9 (3.1) 1.8 (1.2) 17 (11)

4.50-13.50 x 109/L3.69-5.90 x 1012/L 35 45 %

HemoglobinPlatelet Count Neutrophils

5.5 (3.4) 21 (26) 58 (54)

11.50 25.50 gm/ L150 390 x 109/L 37 - 72%

LymphocytesMonocytes ANC

39 (42)3 (4) 1,682 (1,674)

20 50%8 - 14%

Blood Transfusion 1 unit FWB (2nd unit) CBC 6 hours post BT

CBCResult Reference Range

WBCRBC Hematocrit

3.6 (2.9) 2.5 (1.8) 23 (17)

4.50-13.50 x 109/L3.69-5.90 x 1012/L 35 45 %

HemoglobinPlatelet Count Neutrophils

7.5 (5.5) 31 (21) 25 (58)

11.50 25.50 gm/ L150 390 x 109/L 37 - 72%

LymphocytesMonocytes ANC

69 (39)6 (3) 900 (1,674)

20 50%8 - 14%

fever and gum bleeding subsided The condition persisted

Blood Transfusion 1 unit FWB (3rd unit) CBC 6 hours post BT

CBCResult Reference Range

WBCRBC Hematocrit

3.1 ( 3.6)3.70 ( 2.5) 34 ( 23)

4.50-13.50 x 109/L3.69-5.90 x 1012/L 35 45 %

HemoglobinPlatelet Count Neutrophils

11.3 ( 7.5)102 ( 31) 31 ( 25)

11.50 25.50 gm/ L150 390 x 109/L 37 - 72%

LymphocytesMonocytes ANC

61 ( 69)8 ( 6) 961 (900)

20 50%8 - 14%

Blood Transfusion 1 unit FWB (4th unit) Gum and lip bleeding Epistaxis

Condition persisted Referred

Headache Nausea and vomiting Body weakness Anorexia Pallor Dizziness Fast breathing

Birth History born to a 40y G10P10, via NSD at home, attended by a hilot Birth rank 4/10 Growth and Development sit at 7 mos talk at 12 mos walk at 14 mos Grade IV student

Medical Conditions/Past Illnesses/Hospitalizations 2003 (3y) Inguinal Hernia (Iligan City) = herniorrhaphy, left Feb 2012 (11y) Dengue Fever (Amai Pakpak Hosp) No known food and drug allergies Immunization BCG1; Hepatitis B 1, 2, 3; DPT 1, 2, 3; OPV 1, 2, 3; measles; MR

(+) hypertension (+) diabetes mellitus (-) asthma (-) PTB exposure (-) hematologic diseases (-) cancer

General: (-) change in weight (+) fatigue Skin: (-) jaundice (+) dryness Head: (-) injury or trauma

Eyes: (-) pain (-) diplopia (-) blurring vision Ears: (-) tinnitus (-) discharges (-) difficulty hearing Nose and Sinuses: (-) nasal stuffiness and congestion

Throat and Mouth: (-) frequent sore throat (-) dry mouth and hoarseness (-) dysphagia Neck: (-) pain, stiffness (-) swelling Respiratory: (-) wheezing (-) cough Cardiovascular: (-) palpitations (-) orthopnea

Gastrointestinal: (-) heart burn (-) hematochezia (-) melena (-) constipation Genitourinary: (-) nocturia and urinary frequency (-) gross hematuria Peripheral Vascular: (-) claudication (-) leg cramps

Musculoskeletal: (-) limitation of ROM (-) muscle pain (-) joint stiffness Neurologic: (-) memory loss (-) fainting, seizures (-) tingling sensation and tremors

Endocrine and Metabolic: (-) heat or cold intolerance (-) excessive thirst or hunger Mental Status: (-) change in mentation (-) depression (-) anxiety

Conscious, coherent, not in respiratory distress, in pain

Blood Pressure: Pulse Rate: Respiratory Rate: Temperature: O2 Sat

100/60 mmHg 112 beats/min 32 cycles/min 36.8 C 100%

Height: Actual Weight: BMI:

112 cm 30 kg 23.9 kg/m2 (z-score 2)

pale. No jaundice and cyanosis. Nail beds are pale without clubbing. (+) petechial rashes at abdomen Skin is cold and dry with good skin turgor. Capillary refill Time: