CASE-5 DRUG HISTORY
Mr B ,55, Male ,Pilot In Indian Airforce by profession , came to me with failed annual Medical checkup .He had been grounded. He was very anxious to get back to flying. On checking his records he was rejected because his Hb was 10Gm%. No h/O GI bleed.
O/E pulse-64/Min regular, BP-124/84mm ofhg.,JVP-not raised, Oedema-nil, R/R-14/min.
CVS,CNS,Lungs & ABD- NAD
On Investigations- Hb-10 gm% ,GBP- Normocytic normochromic, Serum Iron Lelevs- Normal
PROVISIONAL DIAGNOSIS-NORMOCYTIC NORMOCHROMIC ANAEMIA
He was put on oral Iron and later on Injectable Iron but failed to respond.
DIAGNOSIS-REFRACTORY ANAEMIA
KEY QUESTION-DRUG HISTORY
He was a known case of Hypertension on Telmesartan + Metoprolol . He was taking Amidorone 200mg /day for PVCs.
KEY INVESTIGATION-THYROID PRFILE
RESULT-TSH-132IU/ML
FINAL DIAGNOSIS-REFRACTORY ANAEMIA CAUSE-HYPOTHYROIDISM-CAUSE-DRUG INDUCED-AMIDORONE
TREATMENT-STOP AMIDORONE-PUT ON THYROXINE-MONITOR THYROID STATUS
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