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CASE PRESENTATION
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CASE PRESENTATION

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  1. CASE PRESENTATION BY DR ROHAN

  2. CHIEF COMPLAINTS • FEVER SINCE 1 MONTH • LOSS OF APPETITE SINCE 1 MONTH • LOSS OF WEIGHT SINCE 1 MONTH • WEAKNESS AND FATIGUE SINCE 1 MONTH MALE PATIENT BY NAME XXXXXX YYYYYY OF AGE 51 YEARS

  3. GENERAL & PHYSICAL EXAMINATION • PALLOR • LYMPHADENOPATHY{INGUINAL&AXILLARY} • SPLEENOMEGALY 12 CM

  4. INVESTIGATIONS CBC

  5. PERIPHERAL SMEAR • MICROCYTIC HYPOCHROMIC • LYMPHOCYTOSIS PRESENT • NO ABNORMAL LYMPHOCYTES OR LYMPHOBLAST • ROULEAUX FORMATION PRESENT

  6. LIVER FUNCTION TEST

  7. RENAL FUNCTION TEST

  8. OTHER SPECIFIC INVESTIGATIONS • Serum LDH was normal 281 u/l{reference -225-450 u/l} • ESR was 100mm • Urine routine showed albumin 1+,rest normal • Retic count was normal • Malarial parasite not seen • Serum iron was low-14.47ug/dl • TIBC was 211u/dl • FBS-PLBS normal • CT abdomen showed massive speenomegaly • Serum calcium was 9.60mg/dl • Serum electrolytes were normal

  9. SERUM PROTEIN ELECTROPHORESIS

  10. BONE MARROW ASPIRATE& IMPRINT OF BIOPSY

  11. IMMUNOPHENOTYPING SERUM IMMUNOFIXATION STUDY SHOWED IGM –K MONOCLONAL GAMMOPATHY

  12. FINAL DIAGNOSIS • WALDENSTROM’S MACROGLOBULINEMIA

  13. TREATMENT • PACKED CELLS -4 BAGS • INJ GRANISET 3 MG + INJ PANTODAC 40MG I.V IN 10 ML NS OVER 15 MINS • INJ ENDOXAN 1GM I.V IN 250ML NS OVER 1 HR X 1 DAY • INJ VINCRISTINE 2MG I.V SLOWLY WITHOUT EXTRAVASATION X 1 DAY • TAB OMNACORTIL 20 MG 1-2-2{AFTER MEALS} X 5 DAYS • TAB PAN 40 1-0-1 X 2 WEEKS • TAB ZYLORIC 100MG 1-1-1 X 2 WEEKS • TAB FOLVITE 5MG 1 OD X 3 WEEKS • CAP BECOSULE 1 OD X 3 WEEKS • TAB NEURODAY 1 OD X 3 WEEKS • CAP VITCOFOL 0-0-1 X 3 WEEKS • REPEAT SAME TREATMENT EVERY 3 WEEKS X 6- 8 CYCLES IF EFFECTIVE AND TOLERABLE

  14. RESPONSE TO TREATMENT

  15. RESPONSE AFTER 3RD CYCLE • SPLEEN SIZE- 6CM • HB - 7.9GM% • TLC -9.9 K/UL • PL -148 K/UL • LYM -52% • N –42% • SR CREAT- O.6 MG/dl

  16. THANK YOU