FIGURE1 patient picture, he had features of thalassemia.
3-EXAMINATION
Examination revealed a fully conscious patient (GCS=15), puls 124 beats
per minute, and blood pressure was 100/70mmhg. He was pale and his face
shows features of thalassemia. His cardiac examination revealed normal
first and second heart sound with a humic murmur all over the
pericardium. Other systems were clear on examination.
4-INVESTIGATION
On presentation his blood test showed hemoglobin=6.7 g/dl, mean
corpuscular volume =87.5 fl, platelets=319 x 10^3/Cmm, and WBCs = 8.8
x 10^3. urine analysis the pus cells count was 18-20/HPF, RBCs count
(was 5-7)/HPF. renal function test was normal, electrolyte showed
hyponatremia, hypokalemia, and hypocalcemia. The widal test for brucella
was insignificant. No malaria parasites have been seen in the blood
film. TSH= 2.69, LFT showed AST 21, ALT 15, ALP 159. Abdominal X-ray
showed distended large bowel with an air-fluid level. upper GI endoscopy
was done showing several 2mm red spots in the upper body of the stomach.
Abdomino-pelvic U/S was done and was normal apart from hepatomegaly.
echocardiography was done and was normal. hormonal analysis was done and
showed features of hypo gonads ( LH, FSH, and testosterone were low),
MRI brain was done and showed pituitary macro adenoma. analysis for
somatomedin c was done and was on the lower limit of normal, prolactin
level done and was normal.
Investigation done regarding his long-standning problems of recurrent
anemia, and bloody diarrhea: hemoglobin electrophoresis done was normal,
upper GI endoscopy done show mild lower-end esophagitis with incompetent
cardia, Colonoscopy was done showed inflamed internal piles, serum
amylase = 2064 U/L. Bone marrow aspiration was done and showed
hypercellular bone marrow with no abnormal infiltration. CT’s Chest and
abdomen did and were normal. bilirubin, LDH, serum ferritin, and serum
iron were low, B12 level was high, and BUN/crt was normal. reticulocyte
count was low, the direct coombs test was negative and the viral screen
was negative, the folate level was negative, and the gliadin screen was
less than 0.6.
The last upper GI endoscopy show mild erosion in the stomach and
duodenum, and a colonoscopy was done and showed multiple erosive and
skip lesions, and biopsy was taken and the result showed lymphocytic
infiltration.