instruction: hi doctor my mom is 57 years old she was diagnosed with to disease two months back through exclusion as her tests were negative but she had enlarged lymph nodes in the chest low fever night sweats etc biopsy showed negative for lymphoma and sarcoma she started att medicine and after 10 days she got rashes so the doctor stopped after 10 days she was restarted with att and suddenly she got pura and bleeding from nose and cough she was taken for tests where her platelets came as 100 it has been 12 days and she has been on steroids as sos rivolade past days but the platelets are still below 100 and rec and he are also dropping she is bleeding through urine and stool her other tests are normal including bone marrow biopsy attaching her latest report please advise
output: hello welcome to the icliniq com according to your history it idiopathic thrombocytopenic pura might comes under suspicion but you are not having it as bone marrow is normal and megakaryocyte not showing any sign of it check hypersplenism by us ultrasound abdomen investigation second rule out dengue by ig dengue testing elisa or card test check your kidney profile investigation for serum urea creatinine etc blood infections has to be ruled out like septicemia by blood culture your bleeding and all other complaints are because of low platelets low platelets with bleeding need transfusion of platelet in form of sip or random donor platelet hence first rule out all the above cause if present and then if no cause found we have to strongly suspect autoimmune hemolytic anemia because of your abc report showing normoblast and high reticulocyte count and for that further investigation done with act direct combs test and other suitable workup steroid needed if act is positive and autoimmune hemolytic anemia if confirmed