Janaan heath case report of the week 3 November 2016 A 86 years old lady was brought in to the emergency department by ambulance having complaining of the right leg swelling and lower abdominal bruising for 3 days. She was conscious with GCS 15/15, Blood pressure 100/80 mmhg, pulse 100 sinus, ECG NAD, saturations 100% ambient air Haemodynamically stable in ED Examination by ED registrar revealed Swelling of the right leg up to the mid thigh, very painful to touch with limited movements due to pain She also had left flank bruising. Rest of the system examinations were unremarkable. An initial diagnosis of right leg DVT were She was given a stat dose of LMWH Dalteparin 17000unit sc and an urgent US Doppler was requested, She had blood tests HB 120 WCC 5.6 PLT 340, neutrophils4.5 lymphocytes2.8, LFTs normal, Creatinine 120, urea 12.0, calcium 2.36 APTT 120, PT 12, Fibrinogen 5.9, Thrombin time 20, D-dimmer :normal. Laboratory contacted the responsible medical team on call and Her case was then discussed with haematologist registrar in her first year of training Following the discussion with attending consultant haematologist the patient was seen immediately by haematology team A clinical diagnosis of acquired haemophilia was made. Patient was resuscitated with fluid resuscitations, adequate analgesia Secondary investigations warranted immediately, includes APTT 50/50 mixing study Factor 8 assay Inhibitor assay Patient was given bypassing agent FEIBA (activated PCC) 50unit/kg stat and BD Further detailed history and CT chest neck abdomen and pelvis revealed no significant abnormalities […]

28th October 2016 ,Screening programme in Fenchugonj, sylhet. The child has Pentology of Fellots confirmed on ECHO, now waiting to get his heart operated. He is so active and cheerful but you can hear the fighting sounds he gets on minimal exertion.   Dr Amin Islam, London 7th November 2016 with parental permission.

Janaan health brief case record of the week 1 nov 2016 A 56 years old banker presented to AE with history of being unwell and high temperature for 4 days He was known to have rheumatoid arthritis for 10 years and was on methotrexate 7.5mg once daily. Evaluation in AE revealed pancytopenia with HB 60 WCC 0.1 PLT 10, MCV 90 Chemistry was normal apart from CRP of 300 He was commenced on broad spectrum antibiotics with meropemen and fluid resuscitation. His case was discussed with attending haematologist. A presumptive diagnosis of methotrexate induced panctopenia and neutropenic sepsis were made. Folinic acid and GCSF commenced with the hope of count recovery. The patient was discharged home day 5 with haematology outpatient follow up. He made no haematological recovery week 6 post hospital discharges. He underwent further blood test to exclude MDS/Aplastic anaemia and all were negative. He was commenced on transfusion programme and needed 2 weekly blood transfusion and platelets transfusion weekly to keep at a safer level At week 9 he underwent a bone marrow test Bone marrow test showed advance myelofibrosis grade 4, no excess of blast and no evidence of gross dysplasia. Unfortunately the patient became so depressed with all the events and was at some point become suicidal. Cytogenetics showed – 5q He was then referred to a specialist in London with special interest on MPD/Myelofibrosis. HE was commenced on DANAZOLE with no response after 6 weeks. While he was waiting to get Revlimid he became […]