65 yrs old male pt consulted for fever high grade with chills for 2 days. Pt also has abdominal pain and vomiting 8 days back which were now relieved. Pt has persistent pancytopenia repeated multiple times. Peripheral smear normal except 5%band cells Hb 9.5 tc 3400 and platelet 39000. Rest of cbc normal. Rft, rbs, lft, electrolytes, vitB12 all are within normal range. Dengue, malaria, typhoid IgM negative.
Usg abd only mild splenomegaly. Cxr s\o hilar lymphadenopathy. Ecg showing low voltage otherwise normal. I am suspecting of hypothyroidism or bone marrow pathology. I am planning for tsh, sputum examination and bone marrow biopsy. Kindly give ur valuable opinions.
