Summary
The hypersplenism outcomes Project begins with a conversation that revolves around a 13-year-old female patient diagnosed with pancytopenia secondary to hypersplenism and moves on to also dwell on the insights gained in the previous similar qualitative patient data already archived in our database. The discussion involves a group of medical professionals sharing their insights, workup, and treatment plans for the patient. They also share similar cases from their experience, highlighting the complexities of diagnosing and managing hypersplenism.
Key Words
1. Hypersplenism
2. Pancytopenia
3. Splenomegaly
4. Bone marrow biopsy
5. Splenectomy
6. Medical education
7. Case-based learning
CBBLE UDLCO keyword glossary:https://
Conversational learning Transcripts:
[17/12/2024, 10:31]rb: MOPD 13F studying 8th school with fever and pancytopenia with a clinical massive splenomegaly and delayed sexual maturity joins our other older 21M patient with the same issue and adds to the other two 20F with similar issues we have in our follow up, one of who also had a splenectomy and used to work in@Metacognitist Mover and Shaker1's previous College
[17/12/2024, 10:42] rb : @Communicating Learner 1N23 @ 2022 Kims Med Pg any update on his fever chart following yesterday's admission?👇
@ his uncle says he's actually 21 (although he looks 13) and they may have said 19 earlier
[18/01, 13:59]SR Medicine: @Pushed Communicator 1N22 @ sir, even confirmation of hypersplenism mandates bone marrow's normal or hyperplastic state....
[18/01, 16:41] rb: 👆@SR Medicine @ 2022 PG Medicine @2020 Kims PG Med @Prof just found this online trace of the patient we discussed offline today in the rounds, possibly while evaluating her for the first time in OPD just before her first admission.
Here's her previous EMR summary:
Age/Gender : 13 Years/Female
Address :
Discharge Type: Relieved
Admission Date: 17/12/2024 04:59 PM
Diagnosis:
PANCYTOPENIA SECONDARY TO HYPERSPLENISM ?
CHRONIC ILLNESS
SHORT STATURE - PROPORTIONATE (BMI: 14.6 KG/MSQ.)
Case History and Clinical Findings
PT C/O FEVER SINCE 1 WEEK PT C/O COUGH SINCE 1 WEEK PT C/O COLD SINCE 1 WEEK
PT WAS APPARENTLY ASYMPTOMATIC 1 WEEK BACK THEN DEVELOPED FEVER, HIGH GRADE WITH CHILLS, COUGH WITH SPUTUM, WHITISH, MUCOID, SCANTY, NON BLOOD TINGED, NON FOUL SMELLING.
NO H/O BURNING MICTURITION, PAIN ABDOMEN, VOMITTING NO H/O BLEEDING TENDENCIES
NO H/O BREATHLESSNESS, EASY FATIGUABILITY PAST HISTORY:
N/K/C/O DM,THYROID DISORDERS, HYPERTENSION, EPILEPSY, CAD, CVA PERSONAL HISTORY:
DIET: MIXED
BOWEL AND BLADDER: REGULAR ALLERGIES: NONE
ADDICTIONS: NONE
FAMILY HISTORY: INSIGNIFICANT GENERAL EXAMINATION:
BP: 90/60 MMHG PR: 86 BPM
RR: 16 CPM TEMP: AFEBRILE
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA SYSTEMIC EXAMINATION:
CVS: S1S2+ NO MURMURS RS: BAE+ NVBS
P/A: SOFT, NT BS+, Moderate SPLENOMEGALY
CNS: NFND
ENDOCRINOLOGY OPINION TAKEN ON 20-12-24 I/V/O LESS HEIGHT AND WEIGHT; INAPPROPRIATE SECONDARY SEXUAL CHARACTERISTICS
ADV: CHRONOLOGICAL AGE> BONE AGE> HEIGHT AGE> WEIGHT AGE BONE MARROW ASPIRATION + BIOPSY
TREAT UNDERLYING CONDITION GOOD NUTRITION
HIGH PROTEIN DIET PHYSICAL Exercises
COURSE: A 13 YEAR OLD PT CAME WITH C/O FEVER SINCE 1 WEEK, COUGH SINCE 1 WEEK, COLD SINCE 1 WEEK
VITALS: BP: 90/60 MMHG PR: 86 BPM RR: 16 CPM TEMP: AFEBRILE
ON FURTHER EVALUATION PT WAS DIAGNOSED AS PANCYTOPENIA SECONDARY TO HYPERSPLENISM ? CHRONIC ILLNESS SHORT STATURE - PROPORTIONATE (BMI: 14.6 KG/MSQ.)PT WAS PLANNED FOR BONE MARROW BIOPSY AND ASPIRATION FOR FURTHER EVALUATION. ADVICED TO FOLLOW UP AFTER 1 WEEK. PT WAS DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION.
Investigation
COMPLETE URINE EXAMINATION (CUE) 17-12-2024 10:48:AM
COLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN TraceSUGAR NilBILE SALTS NilBILE PIGMENTS NilPUS CELLS 2-4EPITHELIAL CELLS 2-3RED BLOOD CELLS NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil
BLOOD UREA 17-12-2024 10:48:AM 21 mg/dl 42-12 mg/dlSERUM CREATININE 17-12-2024
10:48:AM 0.4 mg/dl 1-0.5 mg/dl
LIVER FUNCTION TEST (LFT) 17-12-2024 10:49:AMTotal Bilurubin 0.58 mg/dl 1-0 mg/dlDirect Bilurubin 0.16 mg/dl 0.2-0.0 mg/dlSGOT(AST) 41 IU/L 31-0 IU/LSGPT(ALT) 16 IU/L 34-0
IU/LALKALINE PHOSPHATASE 306 IU/L 369-54 IU/LTOTAL PROTEINS 7.9 gm/dl 8-6 gm/dl
ALBUMIN 4.2 gm/dl 5.4-3.8 gm/dl
A/G RATIO 1.16SERUM ELECTROLYTES (Na, K, C l) 17-12- 2024 10:49:AM
SODIUM 138 mmol/L 145-136 mmol/L
POTASSIUM 4.1 mmol/L 5.1-3.5
mmol/L
CHLORIDE 99 mmol/L 98-107 mmol/L
T3, T4, TSH 18-12-2024 12:12:PM
T3 1.29 ng/ml 1.87-0.87 ng/ml
T4 10.23 micro g/dl 12.23-6.32
micro g/dl
TSH 0.86 micro Iu/ml 5.36-0.34 micro Iu/ml USG REPORT:
IMPRESSION: BORDERLINE SPLENOMEGALY
Treatment Given(Enter only Generic Name)
SYP ASCORYL LS 10 ML PO/TID
Advice at Discharge
BONE MARROW ASPIRATION + BIOPSY GOOD NUTRITION
HIGH PROTEIN DIET PHYSICAL EXCERCISES
Follow Up
REVIEW TO GM OP AFTER 1 WEEK FOR BONE MARROW BIOPSY AND ASPIRATION OR SOS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER SIGNATURE OF PG/INTERNEE SIGNATURE OF ADMINISTRATOR SIGNATURE OF FACULTY
Discharge Date
Date:20-12-24
Ward:FMW
Unit:II
[18/01, 16:43] rb: To quote:
"In 1955, Dameshek (7) summarized that hypersplenism should be diagnosed in the presence of four conditions: i) monolineage or mutilineage peripheral cytopenias; ii) compensatory hyperplasia of bone marrow; iii) splenomegaly; and iv) correction of cytopenias after splenectomy. Although these four conditions do not always apply to all cases, they have been commonly cited in the literature, and are important in the diagnosis of hypersplenism."
[18/01, 17:30] SR Medicine: Appreciate PG @ 2022 PG Medicine for very good documentation of all the workup sir, I myself recollected the discussion after endocrine consultation, and Kudos🙌 to you @ for creating a data retrievable platform and being able to use it as and when necessary....
[19/01, 19:14] rb: Speaking of data retrieval in the context of this current 14F while we still don't have her case report made, we do have, as part of our unexplained hypersplenism and splenectomy outcomes project, a similar case of a 14M with hypersplenism who also got operated, logged by our previous PG @2020 Pg Med here: https://raveen07.blogspot.com/
Similarly another patient of 14F here: https://pajrcasereporter.
with hemoglobinopathy which is again a close differential in the current patient for which we deferred her bone marrow aspiration biopsy after yesterday's discussion and decided to await her Hb electrophoresis report along with iron profile perhaps empirically see the response to injection Vitamin B12 as per @2020 PG Med 's readings.
Here's another slightly older patient of hypersplenism in our follow up who also had a splenectomy and is doing well https://snehalmvs.blogspot.
Further retrospective on the anemia clinical complexity project: https://medicinedepartment.
Other than the above recent similars with hypersplenism is a 21M still looking for someone who may do his splenectomy and we came close to getting his RBC scan that suggests splenic sequestration after we referred him to Gandhi Medical College once our anesthesiology rejected him as too complex for a rural medical college! Currently he's being worked up further in hematology, NIMs Punjagutta. More about him here: https://pajrcasereporter.
Thematic Analysis
_Codes_
1. Hypersplenism diagnosis
2. Treatment options
3. Case-based learning
4. Medical education
5. Patient management
6. Splenectomy outcomes
_Themes
1. _Hypersplenism Diagnosis and Management_: The conversation focuses on diagnosing and managing hypersplenism, highlighting the importance of bone marrow biopsy and splenectomy.
2. _Case-based Learning_: The discussion involves sharing similar cases, emphasizing the value of case-based learning in medical education.
3. _Medical Education and Patient Management_: The conversation underscores the importance of medical education in patient management, particularly in complex cases like hypersplenism.
Learning Points
1. _Importance of Bone Marrow Biopsy_: Bone marrow biopsy is crucial in diagnosing hypersplenism and guiding treatment plans.
2. _Splenectomy Outcomes_: Splenectomy can be an effective treatment option for hypersplenism, but outcomes may vary depending on individual cases.
3. _Value of Case-based Learning_: Case-based learning is essential in medical education, allowing healthcare professionals to share experiences and insights.
4. _Complexity of Hypersplenism Diagnosis_: Diagnosing hypersplenism can be complex, requiring careful evaluation of patient symptoms, laboratory results, and imaging studies.
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