Dear Sir, My Mother (Age 61, Weight 100 Kg) Is

Dear Sir,

My mother (Age 61, weight 100 Kg) is having the problem of low platelet count. It was first deduced in the year of Dec-2013 when she had developed UTI infection (and Bacteria was E- Coli)

History of my mother : High Blood Pressure. On Medication; Amploress 10mg BD, WIN BP MT 50 mg (Metoprolol 50 MG+ Olmesartan medoxomil 20 MG)

At that time her TLC=15740, Platelet =70,000 doctor had given IV Injection Amikacin (Urine Culture report said, it was Sensitive) but here platelet was reducing continuously, it come down to 32,000. Doctor advise us to go for the Bone marrow test at Ganga Ram Hospital, Delhi.

Bone- Marrow Says : Celluar bone marrow imprints smears show myeloid prepoderance and toxic granulation. peripheral smear shows thrombocytopenia with neutrophillic leucocytosis and monocytosis. Megakaryocytes are not seen.


We have gone for the test but noting come out. Patient recovers from the UTI and it was found that patient had Thermocytopenia.

Now Approx one month ago; she had the compalain of fever; then we went to the physician he had advised
Tab Cefime 250 + Eztromycin 200 mg for 3 days along with PCM (SOS) .
After taking the medicine for 3 days fever comes around 2-3 hours in a day. Then we again went to the doctor he advised F-7 test .

Then TLC=16,200 ,Platlet=48, 000 , Thyphoid IGM was reactive.

He advised to take tab Ceftum for 2 days and Oflox 200 mg for 2 days but again she had the complain of fever around 2-3 hours in a days. Again doctor prescribed CBC on dated 09-04-2016 Then TLC=15900 and Platllet =40,000

Then patient had given Injection IV Monosef SF for two days and F-7 Was repeated on (15-04-2016) then
TLC = 12420 Platlet Count 15,000

We went to the Artemis. Gurgaon where hematologist (Dr. Rahul Bhargav and Its Team) did the test again;
there Platelet was recored 6000 and TLC Was 12200. Platlet transfusion had been done and Injection Magnex Forte IV has given. during treatment fever was not coming to her.
During that tenure doctor has done the Bone marrow Aspiration, Biopsy, Endoscopy of Liver, ECHO, Fibroscan of LIVER but report was normal.
She had been dischared on 22-April-2016. doctor had been added Tab Revolid 50 MG OD, Ertyopoietin 40000 IU once a week and TAB Amoxycillin 500 mg TDS, (attached Discharge Summary).

Doctor said that she had the problem of MDS.

Bone Marrow Report :

1) Hypercellular bone marrow biospy with trilenage hematopoiesis.
2) Myeloid Hyperplasia with prominent CD 117+ mast cells.
3) Megakaryocytes with atypical features such as few micromegakaryocytes.
4) See additional remarks:
Marow Cellularity : Hypercellular Marrow
Marrow Cellular Composition Trllineage
Erthroid maturation shows mild erythorid hyperplasia (Glycophorin +)
Megakaryocytes : Present with alypical features such as few hypolobated forms and few micromegakaryocytes (FVIII+)
Reticulin shows focal 1 + to 2+ Fibrosis
Iron Stain Minute Amount
Special Stains : Iron and Reticulin
Immunostains performed are CD3,CD20,Cd34,CD117, FVIII,CD138,Kappa, Lambada, MPQ, Glycophorin, CD68
All controls shows appropriate reactivity.
Immunostains with CD34 highlights rare blast. CD117 shows positivity in eryhroblast as well myeloblasts (3-4%) and it also highlights prominet mast cells. Few Plasma Cells shows coexpression with CD117,Cd138, Kappa,Lambda show 2-3% polyclonal plasma cells. FVIII hihglights atypical megakaryocytes. MPO Shows positivity in myeloid cells. Glycophorin shows positivity in erythroid cells and CD68 shows positivity in few monocytes CD3 and CD20 highlight 2-3 lymphoid folicles with express both T and B lymphocytes.
Morphological findings in conjuction with clinical history of anemia and thrombocytopenia raise a possibilty of Myelodysplatic Syndrom. However this dianoisis should be confirmed by a chromosome analysis and molecular studies for Leukovantage testing (92668X).

When we came to the home, she again had the complain of fever (2-4 hours a day; around 99 to 100) .
We went to the hospital again; doctor did the CBC and Platelet = 8000, TLC 15200 .

She was again admitted to the hospital (28-04-2016) that doctor did the PET scan (report Attached noting comes out in the PET Scan).

Doctor had started injection Elores 3 Mg ( Ceftriaxone ) IV.

From the last 2 days doctor has been started Steroid but as per today report here Platllet =8000 and TLC Was 11700and she is still in the hospital.

your kind advise is needed. Right now she is having the

Tab Folvite 5 mg OD
Tab Meganeuron Od
Tab Trenexa 500 mg TDS
tab Revolade 50 mg OD
Tab Wysolone 100 mg OD
Tab Panto 40 MG OD
Tab Telma- HD 40 mg Od
Cap Cyclosporin 150 mg BD
Inj Erthopoetin 40000 IU (weekly)

Your advise is needed.