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woman inject boy on arm

It is a rainy day, the doctor is as usual busy in his clinic. The closing time approaches (9 PM). Due to heavy rain doctor decides to stay back and wait in the clinic. Suddenly a worried couple rushes inside clinic with their 10-year-old son. As it was past working hours, the couple request doctor to check their son.

Doctor calms down tensed parents and tells them not worry. He asks ‘What is the problem?’, parents anxiously reply ‘Doctor our son is having high fever with chills from past 5 days. He has severe body ache, joint pain and heaviness in head. Our son keeps crying all day and refuses to get up from bed because of body ache. We are giving him medications but fever keeps coming back. Please help us doctor!

Doctor listens to the parents, nods his head, and continues examining the boy. The child’s vitals were normal and there was no significant past medical history. Other than the present symptoms the child looked completely normal. Doctor advises to get blood examination- ‘Complete Blood Count (CBC)’ done. For now, he prescribes paracetamol and asks them to get back at the earliest with blood report.

Next morning, parents visit the doctor again. As soon as the doctor looks at blood report he becomes quite sure of what has happened and advises to immediately hospitalize the child.

On hospitalization, the confirmatory blood test was done and doctor was proven right in his diagnosis. Ultrasound was done and it showed mild hepatomegaly. Doctor started the child’s treatment with intravenous fluids, regular pain killers, and paracetamol. Plenty of fluids, specific fruits, and a healthy diet were provided to child by the hospital. Initially, CBC was done daily to keep a check on blood cell count. After 3 days blood test was done alternatively. There was improvement in the child’s health in 2-3 days of hospitalization and on 5th day the boy was discharged.

Questions –

What do you think was there in the blood report?

What was the final diagnosis?

Answers with explanation

1) What do you think was there in the blood report?

The doctor had asked to get Complete Blood Count done for the child. The report showed significantly lower platelet counts – 60,000 cells/microlitre and the normal platelet count is around 2-3 lakh cells/microlitre.

2) What was the final diagnosis?

The child was suffering from Dengue. Significantly lowered platelet counts with mild hepatomegaly directs towards dengue.

Clues given in the case are as follows-

CBC – CBC measures Blood cell count, So look for diseases that influence blood cell count. WBC counts always vary when there is an infection in the body, but platelet count remains the same. Any changes in platelet count is itself an obvious indication.

Fever with severe body ache – Dengue is also called Bone Fever. It causes unbearable pain in the body and makes the patient weak. Performing day-to-day activities also becomes difficult.

Treatment Plan – Paracetamol and pain killers were prescribed with IV fluids. Dengue if not complicated by secondary infection requires only paracetamol and plenty of fluid consumption. Focus on diet with special fruits is also an indication, as dengue patients are fed with papaya and kiwi fruits. These fruits are known to increase platelet count.

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