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Suggest Treatment For Ulcerative Colitis
Question: XXXX
32 years
Female
Married
2 kids
5+ daughter( normal)( march 2009)
2+ son( sygerien)(Dec 2012)
Diagnosed with ulcerative colitis in November 2010 for the first time.
Colonoscopy held
Ulcerative colitis (40 cm).
Started mesacol and omnacortil. For 2 months.
Setelled.
Again had an attack of ulcerative colitis in XXXXXXX 2013.
Same procedure and treatment was repeated.
Again had 3rd attack in July 2014.
Again same procedure for 3 months.
But this time after having medication for 2 months colitis didn't settled and bleeding started again.
Doctor suggested surgery.
We took second advice n this time doctor advised mesacol and AZORAN.( Oct 2014)
After taking this medicines for around 45 days ...all of a sudden her hair start falling and within 3 days she was almost bald.
She had mild fever n infection
Doctor gave normal antibiotics.
Things didn't worked out
She had a wooden flake inside second finger which she got punctured with local doctor nearby....that finger is still black..and is paining.
Her gums started swelling and had pain in mouth.
We got CBC done and found :
HB: 7.5
TLC: 1.3
Netrophills: 1
Platelets: 90.
We got her admitted to fortis hospital under the gastronology team. They started supportive treatment with antibiotics.( drug induced pancytopenia)
CBC didn't improved for 3 days.
We shifted to BLK hospital under hematology team which again started the same supportive treatment with same diagnosed.... Drug induced pancytopenia......
As per them it is severe bone marrow suppression.
2 days....CBC didn't improved....platelets went down to 150000.â¦...HB was 6.5...
3 units of platelets and 2 units of blood was induced in 2 consecutive days.
HB rise to 10 ....TLC 2.6....platelets 88....netrphills ..0.....
One day later although HB sustained but neutrophills remain 0. Platelets again fall to 15000.
Have mild fever.
BMT was done and it was found that its severe A plast anemia....drug induced.
We have been advised marrow transplant.
HLA for donors have been done....report awaited.
Clinically patient is fine.
32 years
Female
Married
2 kids
5+ daughter( normal)( march 2009)
2+ son( sygerien)(Dec 2012)
Diagnosed with ulcerative colitis in November 2010 for the first time.
Colonoscopy held
Ulcerative colitis (40 cm).
Started mesacol and omnacortil. For 2 months.
Setelled.
Again had an attack of ulcerative colitis in XXXXXXX 2013.
Same procedure and treatment was repeated.
Again had 3rd attack in July 2014.
Again same procedure for 3 months.
But this time after having medication for 2 months colitis didn't settled and bleeding started again.
Doctor suggested surgery.
We took second advice n this time doctor advised mesacol and AZORAN.( Oct 2014)
After taking this medicines for around 45 days ...all of a sudden her hair start falling and within 3 days she was almost bald.
She had mild fever n infection
Doctor gave normal antibiotics.
Things didn't worked out
She had a wooden flake inside second finger which she got punctured with local doctor nearby....that finger is still black..and is paining.
Her gums started swelling and had pain in mouth.
We got CBC done and found :
HB: 7.5
TLC: 1.3
Netrophills: 1
Platelets: 90.
We got her admitted to fortis hospital under the gastronology team. They started supportive treatment with antibiotics.( drug induced pancytopenia)
CBC didn't improved for 3 days.
We shifted to BLK hospital under hematology team which again started the same supportive treatment with same diagnosed.... Drug induced pancytopenia......
As per them it is severe bone marrow suppression.
2 days....CBC didn't improved....platelets went down to 150000.â¦...HB was 6.5...
3 units of platelets and 2 units of blood was induced in 2 consecutive days.
HB rise to 10 ....TLC 2.6....platelets 88....netrphills ..0.....
One day later although HB sustained but neutrophills remain 0. Platelets again fall to 15000.
Have mild fever.
BMT was done and it was found that its severe A plast anemia....drug induced.
We have been advised marrow transplant.
HLA for donors have been done....report awaited.
Clinically patient is fine.
Brief Answer:
Bone marrow transplant essential.
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Jyothi BL and I will be answering your query.
Sorry to know about her present condition.
Based on history provided, my opinion is as follows:
1. She has developed azoran induced pancytopenia. It is very much known to affect marrow and suppress cell production. So much amount of damage is rarely seen and usually it stops, once the drug is stopped. However, here more immune mediated damage might have contributed.
2. Platelets are reducing due to immune thrombocytopenia. Damage of donor platelets is occurring, which has reduced her platelet count. Gum swelling is due to mild internal bleeding due to grinding of teeth during chewing of food, and hence pressure on gums. Once immunity improves, cellularity improves, the black spot in finger will improve.
3. Possible serious damage has led to pluripotent (precursor cells of blood cells) being damaged. Replacement by bone marrow transplant of these pluripotent cells will improve her. At present she is in good hands, and she has not been exposed to infection. Avoid exposure to infection, as it will be difficult to control in pancytopenia.
4. Bone marrow transplant is the treatment of choice as all other modalities have failed.
Hope it helps.
Any further queries, happy to help again.
Dr. Jyothi BL
Bone marrow transplant essential.
Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Jyothi BL and I will be answering your query.
Sorry to know about her present condition.
Based on history provided, my opinion is as follows:
1. She has developed azoran induced pancytopenia. It is very much known to affect marrow and suppress cell production. So much amount of damage is rarely seen and usually it stops, once the drug is stopped. However, here more immune mediated damage might have contributed.
2. Platelets are reducing due to immune thrombocytopenia. Damage of donor platelets is occurring, which has reduced her platelet count. Gum swelling is due to mild internal bleeding due to grinding of teeth during chewing of food, and hence pressure on gums. Once immunity improves, cellularity improves, the black spot in finger will improve.
3. Possible serious damage has led to pluripotent (precursor cells of blood cells) being damaged. Replacement by bone marrow transplant of these pluripotent cells will improve her. At present she is in good hands, and she has not been exposed to infection. Avoid exposure to infection, as it will be difficult to control in pancytopenia.
4. Bone marrow transplant is the treatment of choice as all other modalities have failed.
Hope it helps.
Any further queries, happy to help again.
Dr. Jyothi BL
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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