A 33 year old female with ITP and dengue hemorrhagic fever

This is an online e log book to discuss our patient identified health data shared after taking his/her guardian signed informed consent. Here we discuss our individual patient problems through a series of inputs from available global online community of experts with a aim to solve those patients clinical problem with collective current best evidence based inputs.This blog also reflects my patient centered online learning portfolio and valuable inputs on the comments box is welcome.I have been given this case to solve in an attempts to understand the topic of patient clinical data analysis, to develop my competency in reading and comprehending clinical data including history, clinical finding, investigation.

A 30 years old female came to opd with chief complaints of bleeding from gums since yesterday morning with multiple reddish swelling in oral cavity

Multiple small swellings all over the body ( petechiae) since yesterday evening

Increased menstrual bleeding since 10 days

Fever since 1 day

History of presenting illness

Patient was apparently asymptomatic then on 14th sep 2021, she had a history of fever high grade associated with chills for 5 days

H/o nausea and vomiting the contents being water and it was non projectile and non bilious

Also had generalized weakness for 5 days.

She was diagonised as viral pyrexia and thrombocytopenia with serocytosis.

She was treated with IV fluids and antipyretics

Platelets on admission was 42000 and it gradually increased to 1.1 lakh in 2-3 days followed which she was discharged and advised to get platelet monitoring after one week. But she failed to get it done.

2 days ago she developed multiple reddish swelling in oral cavity

Gradually progressive

They bleed on touch

On consumption of food?

Not associated with pain

No difficulty swallowing

No history of throat pain

Excessive salivation is present

Is it interfering speech? Yes

Multiple small swelling all over the body (petechiae) are present on upper limbs and on chest

Blanching or not?

History of fever since yesterday morning not associated with chills and rigor and is of low grade

Subconjunctival hemorrhage is present in the right eye

History of blood in urine is present

No history of blood in stools, hemoptysis or hematemesis

Menstrual history

Age at menarche is 13 years

Regular cycles for every 28 days and flow is for 3 days

No of pads used is 2 per day

No clots or dysmenorrhoea

Her last LMP was on 1st October and she had spotting on 11th October and no soakage of pad

She had history of 6 abortions in the past due to bleeding pv during pregnancy

Marital history:

Age at marriage 16 years in 1999

she used to go to work with her husband ( Her husband is a tractor driver by occupation and also make bore wells in agriculture fields.

Abortion 1: in March 2001

After 1 and half years of marriage, she conceived spontaneous and in first trimester she developed bleeding PV and there was a spontaneous abortion at 2 and a half months

Abortion 2:

After 6 months of 1st abortion , she conceived spontaneously and with in first trimester(around 10 weeks) ,she developed bleeding PV and there was a spontaneous abortion.

Abortion 3:

She conceived spontaneously 6 months after second abortion

She was very much careful this time and used to have regular follow ups with the treating doctor.Till 6 months of pregnancy, there are no complaints. At 6 months of pregnancy, according to patient , because of lifting heavy weights she had PPROM and IUD and the treating doctor induced labour for the expulsion of fetus.

Abortion 4:

After 1-2 years of 3rd pregnancy , she was conceived again and spontaneous abortion with in 1st trimester at 3rd month

Abortion 5:

After loss of 4th pregnancy, patient went to infertility doctor?? Took treatment for infertility for around 2-3 years , then she was conceived and there was pregnancy loss with in 3rd months and was spontaneous

Abortion 6: in July 2021

After 5th pregnancy , patient stopped visiting doctor and fed up with treatment and After 3 years she conceived spontaneously and there was a pregnancy loss with in 3 months.

From then patient didn't conceive and adopted a female child from her younger brother and taking care of the child.

Past history

The patient was born on 1983

All the milestones were achieved

Immunization done

She was normal up to 12 years of age , At the age of 12, she developed swellings under the mandibular region B/L , roughly about 2x2 cm ( left side size more than right ) .which was rapidly increased in size in about 10 days associated with fever and

She was operated with submental incision and swellings were removed.

19 years of age:*

At 19 years of age patient developed swelling inside the throat with pus(??pustular tonsillitis) .The uncle of the patient took a beedi with fire and passed through her nose and touched the beedi with the swellings.According to the patient ,the swellings was reduced and till now there is no history of swelling inside the throat.

Not a known case of hypertension, diabetes, CAD, asthma, epilepsy, thyroid

Family history

Insignificant

General physical examination

Patient is conscious coherent and cooperative

She was examined in a well lit room and with informed consent

Pallor is present

No icterus, cyanosis, clubbing, lymphadenopathy, edema

Vitals on admission :

Temp 99F

PR 94 bpm

BP 100/60 mmhg