Pancytopenia under evaluation

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 CASE PRESENTATION:

A 50y old male patient came to opd withc/o shortness of breath and fever since 5 days

Patient was apparently asyptomatic 7 years back , 

later he had constipation and painful defecation ass. With blood streaks in stools on and off

Later 5 yrs back he had shortness of breath (grade 2)associated with pedal edema (till ankle)on and off (hb-7.5g%)

later  since 5 days he developed generalized weakness and shortness of breath.SOB(grade2-NYHA) was insidious in onset, progressive in nature , aggravated by climbing uphill and relieved on rest

He also had fever since 5 days ,low grade not associated with chills and rigors

No h/o palpitations,vomitings,chest pain,cough,melena,hemoptysis,hemetemesis , yellowish discolourtion of urine ,bleeding per rectum.

PAST HISTORY:No Not k/c/o DM,HTN,asthma,CKD,CHD

HABITS: He was on mixed diet, appetite normal, constipation only on high protein diet and on alocohol intake,

Occasionally alocoholic (whisky 90ml)

GENERAL EXAMINATION: pt is conscious, coherent, cooperative and oriented to time, place and person

pallor :present

No icterus,cyanosis,clubbing,lymphadenopathy ,koilonychia,

pedal edema present (grade 2)pitting type

VITALS:

Temperature-AFEBRILE

BP:120/70mmhg

PULSE:98bpm

RR:22cpm

Spo2:98% on RA

GRBS:126mg/dl

CVS:s1 s2 heard, no murmurs

RS: BAE clear, normal vesicular breath sounds heard,no added sounds

PER ABDOMEN:O/E soft, non tender, bowel sounds heard,umbilicus: inverted

CNS: higher mental functions: normal

        Cranial nerves: intact

       Motor system: intact

       Sensory system: intact

INVESTIGATIONS:

Reti count : 1%

Corrected reti count :0.30 suggestive of hypoproliferative anemia .

2 prbc transfusions are done

PROVISIONAL DIAGNOSIS: PRIMARY MYELOFIBROSIS