1. DEPARTMENT OF PAEDIATRICS. CASE PRESENTATION. BY DR. BUSINGE.

2. PATIENT’S DEMOGRAPHICS. NAME: AA AGE: 9/12 ADDRESS: Kyamuhunga, Ishaka. NOK: Mother. RELIGION: Catholic. DOA: 05/ 08 / 2014.

3. HISTORY C/O : Excessive Bleeding from the gum ………3/7. -Referred in from KIU (Parent’s request ) -Bleeding followed injury to the gum after a fall. -2 nd episode of bleeding from the gum. -Bleeding from canular site. - Requiring blood transfusion. -1 st episode was 3/12 prior to this admission and this followed injury of the gum by the sweet he was admitted at KIU for 6/7.

4. No history of bleeding without injury. No bleeding in the joint or easy bruisability. R.O.S : R/S: Fast breathing, no cough, no wheezing, no coryza. Other systems normal history.

5. PMH. As above. Life and development history: Normal. Fully immunized. FSH: 4 th born, 3 rd boy. No familial history of bleeding disorder or chronic illnesses. Parent’s peasant farmers. Financial support is by the uncle.

6. Summary. 9/12 old male with recurrent, excessive and prolonged bleeding requiring blood transfusions. Bleeding followed minor trauma.No familial history of bleeding disorders. O/E sick looking, A +++,J o,DEH 2 O o, (C C) o T= 36.3. No L/pathy No Petechiae and No Ecchymoses. Swollen scalp from right parietal region up to the right periorbital region, overlying skin shinny, pitting and non tender. Mouth parked: Gauze soiled with blood. Oozing of blood from a small ulcer on the gum.

7. P/A : Normal fullness and soft. Tender hepatomegaly and no splenomegaly. CVS : warm peripheries, cap refil 2seconds. P/R – 146BPM regular. Normal volume. HS 1 AND HS 11 & no added sound. CNS : Irritable, alert, A/F- normo- tensive neck soft, kernig’s –ve.

8. PNS & MSS: Normal. R/S : Mild distress. R/R = 57BPM. Rest of R/s exam normal. PROBLEMS 1 ) Bleeding from the gum following trauma. 2 ) Severe anaemia with H/F

9. DIFFERENTIALS Coagulation disorder : - Platelets dysfunction - Thrombocytopenia - clotting factor deficiency. INVESTIGATIONS. FBC : Low HB 4.6g/dl, normal platelets value. Thin film: normal. Bleeding time : normal. Clotting time: prolonged. aPTT : Prolonged. PT: normal.

10. TREATMENT Blood transfusion. Controlled the bleeding. Referred the child to paediatrics hematologist for factor level evaluation. FOLLOW UP. Had low factor viii. Now on factor viii replacement therapy.

11. THANK YOU FOR LISTENNING.