1. Major case presentation Dimorphic anemia

2. SCENARIO: Here is a 35years old female patient admitted in medicine female ward diagnosed as dimorphic anemia was hospitalized for 6 days. CHIEF COMPLAINTS: c/o breathlessness since 15 days c/o giddiness since 15 days HISTORY OF PRESENT ILLNESS: Patient was apparently alright 15 days back then she developed breathlessness, insidious in onset and progressive. Patient also complains of giddiness even at rest gradually progressive. PAST MEDICAL HISTORY: Patient is a k/c/o anemia blood transfusion was done when she delivered second child

3. LABORATORY INVESTIGATION: Peripheral smear report: Dimorphic anemia with leucopoenia with mild thrombocytopenia
Test
Patient value
Normal value
WBC
4500 cumm
cumm
RBC
1.12 million/μl
million/μl Hb
4.5 g/dl
11-14g/dl
PCV
12.3 %
35-46%
MCV
109.8 fl
80-100fl
MCHC
36.6 g/dl
32-36 g/dl
MCH
40.2 g/dl
ESR
70 mm/hr
<20 mm/hr
MPV
13.0 fl fl
PDW
15.7 fl
10-14 fl
Platelet count
1.50
1-3 lakhcell/cumm

4. General physical examination:
Pallor +
SOAP NOTE:
Subjective:
Here is a 35 years old female presenting complaints of breathlessness
and giddiness since 15 days.
Objective:
RBC is decreased that indicates anemia.
Hb is drastically decreased which indicates severe anemia
ESR is increased due to infection
PCV is decreased that indicates over hydration or due to anemia or blood loss.

5. MCV & MCH values are increased which indicates macrocytic & hyperchromia.
RDW (RBC distribution width)the normal values are found in anemia.
MPV (mean platelet vol ) is increased it indicates there is destruction of platelets. (Alloimmune thrombocytopenia - eg, neonatal, post-transfusion)
PDW (platelet distribution width) is increased it indicates high PDW means that platelet size varies greatly, a sign of active platelet release.
Peripheral smear shows that dimorphic anemia with leucopeonia with mild thrombocytopenia.
Diagnosis:by observing the above subjective and objective data the patient is diagnosed with dimorphic anemia.

6. ASSESSMENT:
Problem list:
1.Breathlessness
2.Giddiness
3.Dimorphic anemia
-Breathlessness:
It is due to anemia the oxygen carrying capacity is decreased.
-Giddiness:
It is due to anemia
Dimorphic anemia : is a dual population of RBCs in the peripheral
blood smear with both microcytic hypochromic and normocytic
macrocytic red blood cells which is a typical finding of iron
deficiency vitamin B12/folic acid deficiency anemia.

7. PLAN OF CARE: Goals of therapy:
To alleviate signs and symptoms
Correcting the underlying etiology
Prevent reoccurence of anemia.

8. S.no
Brand name
Generic name
Dose & freuency
Day 1 2 3 4 5 6 1.
IVF dextrose
500ml Y 2.
O2 inhalation 3.
Inj.Bactocef iv
Cefuroxime
1gm
1-0-1 4.
Inj.Pantox iv
Pantoprazole
40mg
1-0-0 5.
Inj.P-cet iv
Ondansetron
1amp
1-1-1 6.
Syp.Hemowin
Oral iron supplement
2tsp
0-0-1 7.
Inj.Vitcofol im
Folic acid
2cc
0-1-0 8.
Cap.Fesovit
FA+nico+B6+B12 + Feso4

9. Drug-drug interactions:
Cefuroxime + pantoprazole - decreases the absorption of cefuroxime
Monitor CBC for the normal levels RBC,Hb
Patient counselling:
Patient is advised to take iron rich diet such as green leafy
vegetables, fruits, egg, liver, kidney etc,
Discharge drugs:
1.syp.Hemowin 2tsp x 10 days
2. cap. Fesovit x 30 days
3. Inj. Vitcofol 2cc im alternate days for 1 wk.

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