{"ops":[{"insert":"A 63 year old woman presents with melena for 3 weeks, and fatigue and malaise for 2 weeks. No other symptoms were present.\n\nHer medical, surgical and drug histories are unremarkable, and there is no family history of bleeding disorders or gastrointestinal malignancies.\n\nShe does not smoke, and only drinks socially.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-120_en.png"}},{"insert":"\n"}]}
2
Investigate
Complete Blood Count + Peripheral Smear
{"ops":[{"insert":"Hb: 7.5 g\/dL (12.0-15.0)\nRBC: 2.52 x 10^6\/mm3 (4.0-4.9x10^6)\nReticulocytes: 2.5% (0.5-1.5)\nWBC: 5,900\/mm3 (4,500-10,500)\nPlt: 144x10^3\/mm3 (150-400x10^3)\n\nThe peripheral blood smear shows immature myeloid cells, tear-drop shaped cells, nucleated red cells, and giant platelets.\n"}]}
Liver Profile + Ultrasound Abdomen
{"ops":[{"insert":"AST: 17 IU\/L (8-48)\nALT: 17 IU\/L (7-55)\nALP: 771 IU\/L (45-115)\nLDH: 525 IUL (122-222)\nGGT: 86 IU\/L (9-48)\nTotal protein: 7.0 g\/dL (6.3-7.9)\nAlbumin: 3.9 g\/dL (3.5-5.0)\nTotal Bilirubin: 2.63 mg\/dL (0.3-1.9)\nDirect Bilirubin: 0.76 mg\/dL (0-0.3)\nHepatitis B and C virus markers: negative.\n\nThe ultrasound scan of the abdomen reveals massive splenomegaly and a dilated splenic vein. The liver appears normal, with no features suggestive of cirrhosis.\n"}]}