36 years old, a housewife from Bakri, Muar admitted 4 days back
because of regular check up and blood transfusion
given. In the pass three years, patient has been
coming to Hospital Muar for blood transfusion every
month due to anemia. But patient don’t know the exact
cause for anemia. Initially patient never developed
any anemic symptoms and problems. Only in the pass
three years after she diagnosed with end stage renal
failure she started to have the anemic symptoms like
easy fatigability, lethargy and dizziness but most of
the time the patient notice she got anemia only after
the monthly regular check up and blood transfusion
will be given. She diagnosed with end stage renal
failure in year 2003. In year 2003, she began to
develop nausea, vomiting and itchiness (uremic
symptoms) and swelling of the legs, decrease urine
output, lost of appetite, lethargy and easy
fatigability. Then she went to hospital and renal
failure was diagnosed. After that she underwent
peritoneal dialysis for 2 years and renal dialysis
till now. On examination she is alert and cooperative,
moderate built and nourished. She present with pallor
and there is no ictherus, cyanosis, clubbing, pedal
edema and lymphadenopathy. Her pulse rate is 78 beats
per minute, respiratory rate is 20 per minute and BP
is 140/80 mmHg. On abdominal examination liver is
palpable with 3 finger breadth and spleen is palpable
and enlarges toward the umbilicus. In blood
investigation, she was diagnosed with hereditary
spherocytosis. In full blood count, she had low RBC
2.8 x 106/uL, Hb 7.3 g/dL and hematocrit 22.3 %. Her
mean cell haemoglobin is 26.3 pg and platelet is 90 x
103/uL. In urea and electrolyte, urea is 16.2 mmol/L.
In urine FEME, blood is trace, protein is + and ketone
is +. In LFT, alkaline phosphatase is 100U/L and
alanine transaminase is 40U/L. In renal profile, serum
creatinine level is 475 umol/L, uric acid is 439
umol/L and urea is 13.3 mmol/L.

Exploring personal and social background:
Patient is a known hypertensive patient for 3 years
after she was diagnosed with renal failure. She
doesn’t have diabetes, asthma, IHD and TB. She never
drinks alcohol and smoke. She was a factory worker in
year 2002 and because of the closing of the factory
she becomes a housewife. She has been married for 18
years and she has four children, 3 sons and 1
daughter. The eldest is 17 years old and the youngest
is 9 years old. During her 4 pregnancy, there were no
major problems or complications present except anemia
but the anemia was under controlled with haematinics.
Her husband is a clerk of a school and his monthly
income is RM1000. Because of the low income, they
can’t afford in paying for the AV fistula procedure
and renal dialysis. Because of this she underwent
peritoneal dialysis for 2 years just to delay the
fistula procedure and renal dialysis which is very
costly for them. After that she gets the support from
government and she began her renal dialysis at one of
the private dialysis centre in Muar till now. She went
for renal dialysis three times a week and each time
will cost her RM 260 and because it is supported by
the government now they no longer worry of the long
term costly treatment anymore. She will go for renal
dialysis without miss except one day she attend an
event and miss one episode of renal dialysis, her
whole body get swollen due to the fluid overload.
During this dialysis period she never developed any
complication because of the dialysis. Initially before
she was diagnosed with end stage renal failure, she
can work very hard and enjoy her life but after she
become a renal failure patient, she can’t do heavy
work anymore, feel tired easily and she only can do
some cooking and housework at house. Also patient feel
very difficult in control her water intake after she
undergo the renal dialysis. But she doesn’t have any
problem in taking care of her children even she need
to go for dialysis three times a week. The major
problem for her is the monthly follow up and blood
transfusion. If she got any health problem she will
come to hospital herself without any help from others.

From:
Haw Keong
(10-5-06 12.30am)