Saturday, May 9, 2009

case study

A 64 year old male with previous history of hepatitis B infection presented with gastrointestinal bleeding. On examination, he was pale and jaudiced and presence of palmar erythema, spider naevi and hepatosplenomegaly.

Investigation results are as follows

Hb 6.2 g/dl
WBC 3.6 X 109/l
neutrophils 1.8
X 109/l
lymphocytes 1.2
X 109/l
platelet 98
X 109/l
PT 20s(normal 12-14s)
APTT 46s(normal 26-33.5s)


1. Discuss the lab results

  • anaemia (indicated by low Hb level)
  • leukopenia (indicated by low WBC count)
  • thrombocytopenia ( indicated by low platelet count)
  • impaired extrinsic pathway (prolonged PT)
  • impaired intrinsic pathway (prolonged APTT)

2. What are further investigations would you consider in this patient

- Liver function test- to look for evidence of liver failure
(oesophago-gastric-duodeno-scopy) - to look for esophageal varices and any other GI bleeding
- stool occult blood - to look for evidence of lower GI bleeding

3. What is the most likely diagnosis

Chronic liver failure

( Chronic Hepatitis B infection cause chronic liver failure in this patient results in cirrhosis of liver parenchyma. Cirrhosis cause portal hypertension leads to esophageal varices and so leads to GI bleeding. Chronic loss of blood leads to anaemia. Cirrhosis also leads to spleen enlargement as a result of portal hypertension. Sequestration of blood cells occur leads to pancytopenia and further aggeravates the bleeding)

4. How would you manage this patient

- Stop the bleeding
- Transfusion of blood product (fresh frozen plasma)



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