– I was called to see a patient (60 year Male ), who was being treated for sepsis, AKI on CKD, with antibiotics, HD, and NIV. REASON TO CALL ME WAS – LOW HB ( 5GM%), LOW PLATELETS ( 1000) AND HIGH COUNT 24000. Thrombocytopenia was not responding to platelets transfusions.
History : Patient was known case of HT, DM ( on treatment ). He has complaint of fever since last one month. He came 5 days ago to the hospital with breathing difficuty and decreasing urine out output. For one month he was tretaed at local place with mutples doctors but no response .
To begin with his HB WAS 10GM%, PLT 76K, TLC 24K. CREAT 5 MG%, ABG 7.36, PCO24, HCO3 22. His platelets dropped rapidly over 5 days to 1000. LFT normal; LDH Normal. Fever still concern. Procalcitonin 20.USG ABDOMEN- B/L CONTRCATED KIDNEYS
Patient alert ,needs NIV, and HD . No response to pitazo and .
Looking to history and course I asked for ESR ,CRP, ANA PROFILE , TOTAL PROTEIN , LDH, FRAGMENTED RBCS , LFT , BLOOD CS, ECHO and repeat USG ABDOMEN.
ONE FINDING WHICH WAS CONSITENT THAT DESPITE ALL THE PROBLEMS – HE WAS NOT HYPOTENSIVE , HE WAS NOT ACIDOTIC AND HIS SOFA SCORE WAS CONSISTENT .
FOLLOWING RESULT CAME – ESR 145, CRP 30, TOTAL PROTEIN 9GM%
ASKED FOR PROTEIN ELECTROPHORESIS – DX CONFIRMED MULTIPLE MYELOMA.
( EXPLANED HIS NORMAL ABG )
PATIENT WENT DAMA DUE TO COST ISSUES.
