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    CC 10 NOv 2017 ITP

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    Lilik Natasubrata
    The morning report summarizes the patient admissions and identities for the day. It includes details of a 3 year old male admitted with sudden bruises, low platelet count, and anemia. His examination shows bruising and signs of malnutrition. The working diagnoses are suspected immune thrombocytopenic purpura, iron deficiency anemia, and wasting. He is receiving steroids, platelet transfusion if needed, and nutritional support. Follow up notes show stable vital signs and no new bleeding.

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    CC 10 NOv 2017 ITP

    Uploaded by

    Lilik Natasubrata
    14 views32 pages
    The morning report summarizes the patient admissions and identities for the day. It includes details of a 3 year old male admitted with sudden bruises, low platelet count, and anemia. His examination shows bruising and signs of malnutrition. The working diagnoses are suspected immune thrombocytopenic purpura, iron deficiency anemia, and wasting. He is receiving steroids, platelet transfusion if needed, and nutritional support. Follow up notes show stable vital signs and no new bleeding.

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    The morning report summarizes the patient admissions and identities for the day. It includes details of a 3 year old male admitted with sudden bruises, low platelet count, and anemia. His examination shows bruising and signs of malnutrition. The working diagnoses are suspected immune thrombocytopenic purpura, iron deficiency anemia, and wasting. He is receiving steroids, platelet transfusion if needed, and nutritional support. Follow up notes show stable vital signs and no new bleeding.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    14 views32 pages

    CC 10 NOv 2017 ITP

    Uploaded by

    Lilik Natasubrata
    The morning report summarizes the patient admissions and identities for the day. It includes details of a 3 year old male admitted with sudden bruises, low platelet count, and anemia. His examination shows bruising and signs of malnutrition. The working diagnoses are suspected immune thrombocytopenic purpura, iron deficiency anemia, and wasting. He is receiving steroids, platelet transfusion if needed, and nutritional support. Follow up notes show stable vital signs and no new bleeding.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    MORNING REPORT

    FRIDAY, 10TH NOVEMBER 2017

    dr. Fitri/ dr. Aya / dr. Dian/ dr. Galih/ dr.Tatag


    dr. Pitra / dr. Ahimsa
    dr. Dhimas/ dr. Mitha

    1
    PATIENT ADMISSION

    MELATI 2 WARD
    A, male, 11 months old, 6 kgs, with acute diarrhea with severe
    dehidration, post ileostomy due to intussusception, wasted.
    A, male, 3 years old, 11 kgs with suspected acute ITP, microcytic
    hipochromic anemia due to iron deficiency dd chronic infection,
    wasted.
    D, 2 months old, 4 kgs, with suspected acyanotic congenital heart disease,
    VSD dd ASD dd PDA, Ross III, wellnourished.
    NEONATAL HCU: -
    PICU : -
    MELATI 2 HCU : -
    NICU : -
    2
    PATIENT IDENTITY

    Name :A
    Sex : male
    Age : 3 years old
    Body weight / height : 11 kgs / 97 cm
    Adress : Pulorejo, Wonogiri
    Medical Record : 01398312

    3
    CHIEF COMPLAINT

    Bruises
    (referred from PKU Solo)

    4
    CURRENT MEDICAL HISTORY

    7 days before 3 days before At ER


    admission admission Patient was fully
    Patient got sudden Patient still had bruises alert, there were
    bruises on both on his cheek, arms, legs some bruises on his
    legs, body and right and body arms and legs,
    arm, history of Gum bleeding (-), No fever, no gum
    trauma (-) nosebleed(-), no fever bleeding or
    Patient look pale nor cough nosebleed, no
    No nose bleed, no His parents brought headache
    gum bleeding, no him to private hospital Defecation and
    fever, cough, vomit, perform laboratory urination within
    Eat and drink examination result normal limit
    within normal limit was very low platelet
    No complaint count (7000/ml)
    about urination got 3 unit transfussion
    and defecation of platelet reffered
    to Moewardi hospital

    5
    PAST MEDICAL HISTORY

    History of hospitalization (-)


    History of same illness (-)
    History of skin and respiratory tract infection (+) in recent
    2 months

    6
    FAMILY MEDICAL HISTORY

    History of hematology disorder in family was denied


    History of same illness in family(-)

    7
    PREGNANCY AND DELIVERY HISTORY

    During pregnancy, his mother routinely checked up her pregnancy


    to obstetrician. She was given vitamin, and she didnt consume any
    medicine beside it. She hasnt got hospitalized during pregnancy and
    has no fever, no hypertension
    Baby boy was born in 39 weeks of pregnancy by spontaneous
    delivery. he cried vigorously, no cyanosis or jaundice. His birth
    weight was 2900 grams, 48 centimeters in length, meconeum was
    found

    Conclusion: Pregnancy and delivery history were normal

    8
    VACCINATION HISTORY

    BCG : 1 month
    Hepatitis B0 : 0, 2,3,4 months
    DPT-HB-HiB : 2,3,4 months
    Polio : 2,3,4 months
    measles : 9, 18 months

    Conclusion :
    complete immunization,
    appropriate with Ministry of Health schedule 2014
    9
    NUTRITION HISTORY

    Patient eat rice, chicken, bef, fish, fruit and some of vegetables. His
    portion usually - adult portion. He also drink milk sometimes
    Conclusion: quantity and quality were adequate

    GROWTH AND DEVELOPMENT


    He is 3 years old now,11 kgs in body weight, 92 cm in lenght.
    Birth weight : 2900 gram
    He can play with his friends, communicate well, he can say 3
    word and form a sentences.
    Conclusion: appropriate for his age 10
    NUTRITIONAL STATUS

    Weight for Age: Weight/Age = -2 SD


    Underweight
    Height for Age: -2 SD< Height/Age < 0 SD
    Normoweight
    Weight for Height : -3 SD< Weight/ Height < -2 SD
    Wasted
    Conclusion:
    Underweight, Normoheight, Wasted (WHO)
    11
    FAMILY TREE

    II

    III

    A, 3 years old 12
    PHYSICAL EXAMINATION

    General appearance :fully alert, GCS E4M6V5


    Vital sign :
    Heart Rate = 118 bpm
    Respiration rate = 24 bpm
    Temperature = 36.6 0 C peraxilar
    O2 saturation = 98%
    Blood pressure = 100/60 mmHg

    13
    Head : mesocephal,, hematom (+)right frontal region
    Eyes : pale conjunctiva (-/-), icteric conjunctiva (-/-), light reflex (+/+),
    isochoric pupil 3 mm/3mm, sunken eyes (-/-), tears (+/+)
    Nose : nasal flare (-/-), discharge (-/-), nosebleed(-/-)
    Mouth : wet lips (+), lips and tongue not cyanotic, cleft lip palate (-), gum bleeding(-/-)
    Throat : hyperemic pharing (-),Tonsil T1-T1 hyperemic (-), detritus (-)
    Neck : Enlargement of lymph node (-)
    Thorax : symmetric (+), retraction (-)

    LUNG:
    I: normal, symmetric, retraction (-)
    P: fremitus difficult to evaluation
    P: sonor in both lung
    A: normal vesicular breath sound, additional breath sound (-/-)

    14
    CARDIAC:
    I : ictus cordis was not visible
    P: ictus cordis was palpable on ICS 4 parasternal lines
    P: cardiac enlargement (-)
    A: 1st 2nd Heart sound normal intensity, regular, no murmur
    ABDOMINAL:
    I: abdominal wall equal to chest wall, hernia umbilicalis (-)
    A: peristaltic sounds normal limit
    P: tympani(+), shifting dullness (-), undulations(-),
    P: liver and spleen was not palpable, good skin turgor
    EXTREMITIES:
    The extremities were warm, capillary refill time < 2 sec, and dorsalis pedis artery
    was strongly palpable, multiple hematom on extremities.
    GENITALIA : , phimosis (-) 15
    LABORATORY FINDINGS

    Hb : 10.2 g/dl
    HCT : 32%
    AL : 11.7 thousand/ul Conclusion :
    AT : 38 thousand/ ul
    - Thrombocytopenia
    AE : 4.17 mil/ul
    - Anemia microcytic
    MCV: 76.0 /um
    hipochromic
    MCH : 24.5 pg
    Netrophyl : 75.40 %
    Limphocyte : 20.10 %

    16
    LISTS OF PROBLEM

    A,3 years old, 11kgs with :


    Sudden Bruises on both arms legs, and face,
    History of trauma (-)
    No gum bleeding, no nose bleed, no fever, no cough,
    Thrombocytopenia
    Microcytic hipochromic anemia

    17
    DIFFERENTIAL DIAGNOSIS

    1. Suspected acute immune thrombocytopenic purpura


    2. Microcytic hipochromic anemia due to iron deficiency dd
    with chronic infection
    3. Wasted

    18
    WORKING DIAGNOSIS

    1. Suspected acute immune thrombocytopenic purpura


    2. Microcytic hipochromic anemia due to iron deficiency dd
    with chronic infection
    3. Wasted

    19
    THERAPIES

    Admitted to pediatric hematology ward


    Nutrition rice pack diet 1500 kkal / day
    IVFD D NS 40 ml/hour
    Metil prednisolone (4 mg/kgBW/day) 50 mg/24 hour I.V.

    20
    PLAN
    1. Peripheral blood smear examination
    2. SI, TIBC, serum feritin, transferin saturation
    examination
    3. Three unit of Platelet transfussion if there is
    spontaneous bleeding

    MONITORING

    General appearance / vital signs / oxygen


    saturation every 8 hours
    Blood glucose every 24 hours
    21
    FOLLOW UP 11TH NOVEMBER 2017

    S : bruise (+) no fever, no vomit, no nausea, cough (+),


    regularly, defecation +
    General appearance : fully alert
    Vital sign :
    Heart Rate = 110 bpm
    Respiration rate = 22 bpm
    Temperature = 36.9 (36.6-37.30 C )peraxilar
    O2 saturation = 98% 22
    Head : mesocephal,, hematom (+)right frontal region
    Eyes : pale conjunctiva (-/-), icteric conjunctiva (-/-), light reflex (+/+),
    isochoric pupil 3 mm/3mm, sunken eyes (-/-), tears (+/+)
    Nose : nasal flare (-/-), discharge (-/-), nosebleed(-/-)
    Mouth : wet lips (+), lips and tongue not cyanotic, cleft lip palate (-), gum bleeding(-/-)
    Throat : hyperemic pharing (-),Tonsil T1-T1 hyperemic (-), detritus (-)
    Neck : Enlargement of lymph node (-)
    Thorax : symmetric (+), retraction (-)

    LUNG:
    I: normal, symmetric, retraction (-)
    P: fremitus difficult to evaluation
    P: sonor in both lung
    A: normal vesicular breath sound, additional breath sound (-/-)

    23
    CARDIAC:
    I : ictus cordis was not visible
    P: ictus cordis was palpable on ICS 4 parasternal lines
    P: cardiac enlargement (-)
    A: 1st 2nd Heart sound normal intensity, regular, no murmur
    ABDOMINAL:
    I: abdominal wall equal to chest wall, hernia umbilicalis (-)
    A: peristaltic sounds normal limit
    P: tympani(+), shifting dullness (-), undulations(-),
    P: liver and spleen was not palpable, good skin turgor
    EXTREMITIES:
    The extremities were warm, capillary refill time < 2 sec, and dorsalis pedis artery
    was strongly palpable, multiple hematom on extremities.
    GENITALIA : , phimosis (-) 24
    DIAGNOSIS

    1. Suspected acute immune thrombocytopenic purpura


    2. Microcytic hipochromic anemia due to iron deficiency dd
    with chronic infection
    3. Wasted

    25
    THERAPIES

    Admitted to pediatric hematology ward


    Nutrition rice pack diet 1500 kkal / day
    IVFD D NS 40 ml/hour
    Metil prednisolone (4 mg/kgBW/day) 50 mg/24 hour I.V.

    26
    PLAN
    1. Peripheral blood smear examination
    2. SI, TIBC, feritin serum, transferin saturation
    examination
    3. Three unit of Platelet transfussion if there is
    spontaneous bleeding

    MONITORING

    General appearance / vital signs / oxygen


    saturation every 8 hours
    Blood glucose every 24 hours
    27
    28
    29
    30
    Bantis Syndrome
    Synonyms of Bantis Syndrome
    Banti's Disease
    Hypersplenism
    Idiopathic congestive splenomegaly
    Idiopathic portal hypertension
    General Discussion
    Banti syndrome is a disorder of the spleen, the large, gland-like organ in the upper left side of the abdomen that
    produces red blood cells before birth and, in newborns, removes and destroys aged red blood cells, and plays a
    role in fighting infection. In the case of Banti syndrome, the spleen rapidly but prematurely destroys blood cells.
    This syndrome is characterized by abnormal enlargement of the spleen (splenomegaly) due to obstruction of
    blood flow in some veins and abnormally increased blood pressure (hypertension) within the veins of the liver
    (e.g., hepatic or portal veins), or the spleen (splenic veins). The disorder may be due to any number of different
    factors causing obstruction of portal, hepatic, or splenic veins including abnormalities present at birth
    (congenital) of such veins, blood clots, or various underlying disorders causing inflammation and obstruction of
    veins (vascular obstruction) of the liver.

    31
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