C09982594 / invoice 10000

Reason: IMT, IMN, Epistaxis History: Presented for recheck CBC and PCV/TP.Reported to be stable at home, no further epistaxis or vomiting. Melena appear to have also resolved as recent stools seem normal. O reports her to still be sleeping lots during the day despite a good appetite. PUPD due to steroid usePreviously noted stable PCV/TP and increasing WBCs. Remains thrombocytopenic. Refer to previous records for full history details. Problem list: 1. Pancytopenia 4/2/26 Pre transfusion PCV 21/51 (5/2/26), Received whole blood transfusion prior to BM biopsy. Histopath (11/2/26) - Marrow myeloid and erythroid hypoplasia, haemosiderosis, plasma cell and lymphocyte infiltrate and mild fibrosis. The possibility of an immune mediated process +/- myelofibrosis cannot be excluded. There is nothing to suggest neoplastic disease. 2. Peripheral oedema 5/2/26 - Resolved Current medications: Sucralfate 1g tablet PO TID Prednisolone 20mg - 2.5tab PO SID Omeprazole 20mg PO BID Tranexamic acid 500mg tablet 1/8 tab PO TID Examination: UPDATEWt 30.5Neurological Mentation: BAR Gait: Ambulatory, no weakness or ataxia Cardiovascular HR: 140bpm MMs: Pink, moist CRT: 1.5s Pulses: Strong and regular Auscultation: No murmurs or arrhythmias Respiratory Rate: panting Effort: Normal Pattern: Costoabdominal Auscultation: Normal bronchovescicular sounds Abdominal palpation: Comfortable Temperature: 39C Laboratory: UPDATEPCV 18%, TP 62g/L CBC - Hct 15.7%; Neu 4.26 x10^9/L; Plt 4k/uL Assessment: CoCo's PCV has remained stable and there are signs of strong regeneration on her CBC and blood smear. WBCs have remained to be wnl. Severe thrombocytopenia persists despite improvements in other cell lines. Holding pattern - to monitor for acute collapse / deterioration at home. Due to no further signs of haemorrhage, haemolysis seems most likely - recommend continue on current pred dosage. Recommended to continue recheck CBC, PCV/TP and blood smear weekly. Bone marrow disease may take weeks up to months to see any response to immunomodulatory medication if any at all. Concerns lie with continued marked thrombocytopenia causing acute and spontaneous bleeding events that may result in stark deterioration of her clinical status (Eg brain bleed / pulmonary bleed etc) Plan: 1. Tranexamic acid 500mg (Cyklokapron 500mg, 1 tab) PO tid 2. Continue on current dose of pred 20mg 2.5tab PO SID 3. Continue sucralfate medication and omeprazole as gastroprotectants 4. RC weekly to repeat PCV/TP and CBC and blood smear    Vital Signs    Weight: 30.5;