Case
severe hepatic failure and hemolysis anemia

Age: 2mths
Sex: Female

History
History of present illness:
Patien had first sign at 2 weeks of age. Dominal sign is severe jaundice. Hepatic failure and hemolysis anemia

Medical History:
No special

Past surgical history:
No

Allergies:
NO

Medications:
Methylprednisolon
Transfusion
Vitamin K


Family history:
Sibling was died at 2 month of age by the same disease.

Social history:
No special


Physical Exam
General:
Alert but irritated
Severe jaundice


Temperature:
High fever at the time hemolysis occur

Heart rate:
Stable

Blood pressure:
stable

Respiratory rate:
Stable

Oxygen saturation:
99%

Head, ears, eyes, nose & throat:
No specific

Neck:
No specific

Chest:
No specific

Cardiovascular:
No specific

Abdomen:
Hepatomegaly 4cm below costal magin
Spleenomegaly 6cm below costal magin
Pheripheral oedema
No ascite

GU:
No bleeding
No specific

Rectal:
No specific

Neurological:
Alert
Irritated, the patien cry all day
Poor feeding

Skin:
Severe Jaundice

Laboratories:
Hb 5,5g/l to 7,8 g/l ( post transfusion)
Reticulocyte 1,5%
Hb in urine positive
NH3 175
Ure 2,5mmol/l
Creatinin 24,4 mcmol/l
protid 39,1 g/l- Albumin 24,6 g/l
Cholesterol 2,8 mmol/l
Bilirubin total 1320 mcmol/ l ( normal 3,4-17 mcmol/l) Bilirubin conjugated 645 and unconjugated 695,6
AST 525U/l- ALT 117U/l- ALP 294,9U/l- GGT 20,9
LDH 767,5U/l ( normal < 450)
Acid lactic 2,3 mmol/l
Prothrombin rate 10%
HbF 34%, HbA1 2,9%, HbA2 63,1%
Test Coombs negative
G6PD is normal
Hepatitis marker: CMV antigen IgG positive, IgM negative. HSV6 and EBV results not yet available




Radiology:
no specific

Problems:
Still unknown the cause of disease and manegement

Discussion:
We would like to receive the consultans from you




Comments
The following are comments made by other users of this site and are not in any way an opinion of thirdspace.org or its staff.


dr hoa8/17/2006 - 1:54:39 AM
Dear Doctor
We have a severe patien still unknow diagnose. It's very helpful for us if we could have some consultancies from you. Thank you very much and looking forward your repply


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