Brief Answer:
ER review important, urine culture to be done

Detailed Answer:
Hi and thanks for the query,

To start with, I humbly believe that considering her age and medical history (diabetes and chronic intake of prednisolone, considering the health consequences, a clinical review in a hospital setting is mandatory to decide if she should be treated as an in patient or an out patient.

Her body hurting all over would need more precision. Any joint pain, swelling? Any fevers or chronic sensation of malaise? IN case these are present, arthritis, and systemic diseases like rheumatoid arthritis, systemic lupus erythematosus and sarcoidosis should be carefully checked for. Rapid tests for evaluation to know if an chronic inflammatory action is going on like the Erythrocyte Sedimentation Rate (ESR) would be most helpful if raised. C reactive Protein Titre is an indirect measure that not only gives an idea of the degree of inflammation, but suggests probable bacterial infections if present. Anti nuclear antibodies, C3 fragment measures, Rheumatoid factor HLA 27 measurement, complete blood count are tests most valuable to decide if there is an infection, if there is a systemic disease or autoimmune responsible for these manifestations or not.

Raised blood sugar levels with prednisolone use makes the classical immunological and inflammatory reactions not very classical. This is a predisposing factor (high blood sugar) for her to develop urinary tract infections. It is imperative considering the state of her bladder to check for a urinary tract infection using more sensitive and appropriate tests like a Urine Culture and analysis. Checking for kidney function is very important under these circumstances.

I strongly suggest you take her first ti the ER room to check for stability of vital signs (general outlook, presence of absence of fatigue, blood pressure, respiratory rate and heart rate). In case of any instability, adequate and appropriate action could be taken, as you await to visit an internist for an in depth review.

Thanks and kind regards.

Dr Bain

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Brief Answer:
Consider splenectomy with hematologist, urine cult

Detailed Answer:
Hi and thanks for the update,

The relatively low platelet count deserves special attention, for it continues to reduce to less than 20K/UL, she might start having spontaneous bleeds. A constant opinion from the hematologist is imperative in this case. I do not know whether the hematologist has checked the splenic function yet. Removal of the spleen at times reduces such low platelet syndromes. It might be worthwhile to discuss this option with your hematologist.

The UTI strip, in my opinion considering her clinical and medical history, positive or negative does not rule out the interest and place of a urine culture and anti biotic sensitivity testing. An experienced gynecologist or urologist at some shall at some point be sought to recheck the bladder function and position. I however believe that the priority in this case is addressing the hematological concern (low platelet count), ruling out possibility of an infectious process, checking out for the causes why she is weak, and also the body hurting. The ascernal of blood tests I suggested above could be helpful.

Thanks and kind regards,

Dr Bain

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