Nursery

Total – 28

Adm – 7

Ward

Total – 55

Admission – 8

. Bleeding diathesis

. Bronchioloitis

Emergency

Total – 110

Male – 60

Female – 50

Admissions – 8

Discharge – 102

Received Dead – 0

OPD – 52

Short stay – 50

. Bronchiolitis

. AWD

. URTI

Fida Hussain s/o Iftikhar Ahmed, 21/2 years old young child, resident of Sialkot admitted via emergency with

c/o :

Easy bruisability – 2 years

According to mother, Child was alright 2 years back when he had gradual onset of easy bruisability at the age of 6 months. There is no history of fever, jaundice, hematemesis, malena, hematuria, epistaxis, gum bleed, prolonged bleeding from the circumcision wound, joint pains, oliguria, progressive pallor. There is history of prolonged bleeding from the site of wound, formation of bruises with minor trauma.

Past history :Patient was treated for the same problem at DHQ Sialkot with 2 blood transfusions 2 months apart and multiple investigations.

Family history :No significant past history of such illness in the family, maternal uncles. No history of tuberculosis in the family.

Drug History :Patient is taking anti-tuberculous therapy for last 7 months.

Birth history :Born via SVD at hospital uneventfully.

Feeding history :Breast fed for 6 months. Patient is now on average family diet.

Vaccination history :Patient is vaccinated according to EPI.

Development history :Developmentally normal

Personal history :Child lives in a house with 2 rooms and 6 family members. Patient is 3rd among the 4 siblings. All the others are normal.Examination :A young irritable child having multiple bruises of multiple sizes and different ages below the eyes, over the trunk and limbs.No pallor, jaundice, lymphadenopathy.HR = 102/min ; Resp = 30/min ; Temp = 99FCVS = S1 + S2 + with no abnormal soundsCNS = IntactGIT = No visceromegalyResp = HVB + with no added sounds

Bruise

Bruise

Investigations :

23-04-11 : Hb 10.7g/dl, TLC 15,200/cmmPlt 8,53000/cmm, ESR 50mm/hr

29-10-11 : Hb 14.2g/dl, TLC 12,300/cmmPlt 6,41000/cmm, ESR 80mm/hrPT 46/14, APTT 64/36, INR 4.69

23-11-11 Hb 12.3g/dl, TLC 13,800/cmmPlt 5,05000/cmm, ESR 37mm/hr

25-11-11 Hb 12.2g/dl, TLC 8100/cmmPlt 6,0800/cmm, ESR 45mm/hr

05.01.12 Pt 13/13, APTT 45/33

08-01-12 Hb 9.9g/dl, TLC 12,100/cmmPlt 5,46000/cmmPT 12/13, INR 0.96Creatinine 0.8, Urea 37Na 134mmol, K 4.1mmolBillirubin 1.1mg/dl, ALT 37U/lBT >8mins

Differential Diagnosis :

. Von-Willibrand disease

. Haemophilia

. Thrombasthenia

THANK YOU !