Patient Copy Pediatric Hematology/Oncology 6-252-122 05-Jul-2012 14:05 Maria Foteini Kallimachou Generated: 8-Jul-2012 10:07
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DEMOGRAPHIC INFORMATION Clinic Number: 6-252-122 Patient Name: Maria Foteini Kallimachou Age: 10 Y Birthdate: 25-Apr-2002 Sex: F Address: 8 Epidavrou Str., Platy City: 2114 Nicosia, CY Service Date/Time: 05-Jul-2012 14:05 Provider: Amulya A. NageswaraRao, MBBS Pager: 3-4097 Service: PDHO Type/Desc: CON Status: Fnl Revision #: 4 REFERRAL Dr. Suresh Kotagal 5-3652 Department of Pediatric Neurology CHIEF COMPLAINT/PURPOSE OF VISIT Elevated fetal hemoglobin noted on testing. HISTORY OF PRESENT ILLNESS Maria is a sweet 10-year-old young girl with a history of Dravet syndrome and intractable generalized tonic-clonic and atonic seizures, followed by Dr. Kotagal in Neurology. She has been referred to us due to detection of an elevated fetal hemoglobin noted on hemoglobin electrophoresis. Her history of seizures dates back to when she was 3 months of age. Following that, in 2008 she was diagnosed with Dravet syndrome. The family is from Cypress, and they here for evaluation once a year. During her evaluation, she had a sleep study done. Following that she had a ferritin level done, which was normal, and also had a hemoglobin electrophoresis done on the 4th of June. I am not quite sure why she had the testing done. On talking to the family, it appears that she was started on a ketogenic diet in 2005. Seizures had stopped until late 2007, and then, since she had further seizures, more medications were added to her regimen. As far as mom can say, she was on Depakene since 1 year of age, was then transitioned to Depakote in 2005. Has been on Topamax since 3 years of age. Also on Klonopin. Currently started on clobazam about a month ago. She is also on Vimpat, started in 2009. Also on L-carnitine. I have reviewed all her labs that we have here since May of 2007. Her lowest hemoglobin recorded is 12.7. Her platelets have varied from 140 to 248, and her white counts have ranged from 3.9 to 6.1, ANC ranging from 1.19 to 2.6. Talking to family, she has never had any infections or admissions secondary to that. She has not had any history of anemia that the mom recalls. Also, on reviewing her labs, her MCV has always been on the higher side, ranging from 88.6 to 92.9. Her ferritin levels have been normal. Her vitamin B12 levels are slightly on the higher side, based on labs from May of 2011. Hemoglobin electrophoresis that was done recently on the 6th of June shows a hemoglobin A2 slightly reduced at 1.9, fetal hemoglobin F increased at 5.6. Also had a beta globulin gene test sequencing done, which was negative. CURRENT MEDICATIONS Bicitra 500-334 mg/5 mL solution by mouth as directed by prescriber. Indication, Site, and Additional Prescription Instructions: Take 2.5 mL twice a day after meals Calci-Mix capsule 500 mg calcium (1,250 mg) by mouth one time daily #1 MONTHS SUPPLY. Indication, Site, and Additional Prescription Instructions: Constipation 1.5 capsule daily with food International patient Children's Multi Vitamins chewable tablet one-half tablet by mouth one time daily.
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Patient Copy Pediatric Hematology/Oncology 6-252-122 05-Jul-2012 14:05 Maria Foteini Kallimachou Generated: 8-Jul-2012 10:07
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Children's Silapap Liquid 160 mg/5 mL 10 mL by mouth three times a day as needed. Indication, Site, and Additional Prescription Instructions: Fever 10 ml three times a day when needed International patient clobazam [ONFI] 5 mg tablet 1 TABLET by mouth as directed by prescriber #1 MONTHS SUPPLY. Indication, Site, and Additional Prescription Instructions: One tab three times a day Depakote 250 mg tablet enteric coated by mouth as directed by prescriber #1 MONTHS SUPPLY. Indication, Site, and Additional Prescription Instructions: Seizure 1.5 tabs in a.m, 1 tab at 2:00 p.m., 1.5 tab at 8:00 p.m International patient Klonopin 0.5 mg tablet by mouth as directed by prescriber #1 MONTHS SUPPLY. Indication, Site, and Additional Prescription Instructions: Seizure 1/2 in a.m, and 1/2 at bedtime International patient lacosamide [VIMPAT] 50 mg tablet by mouth as directed by prescriber #1 MONTHS SUPPLY. Indication, Site, and Additional Prescription Instructions: Seizure one and one half tabs twice a day International patient
levocarnitine [CARNITOR] 330 mg tablet by mouth as directed by prescriber #1 MONTHS SUPPLY. Indication, Site, and Additional Prescription Instructions: one tab three times a day International patient melatonin 3 mg tablet by mouth every bedtime as needed. Indication, Site, and Additional Prescription Instructions: sleep 3 mg at bed onset, 3 mg in the night upon awakening International patient MiraLAX 17 gram/dose Powder 1 packet by mouth one time daily as needed. Indication, Site, and Additional Prescription Instructions: constipation International patient selenium 100 mcg tablet one-half tablet by mouth every morning. Indication, Site, and Additional Prescription Instructions: International patient
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Patient Copy Pediatric Hematology/Oncology 6-252-122 05-Jul-2012 14:05 Maria Foteini Kallimachou Generated: 8-Jul-2012 10:07
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Topamax 25 mg tablet 1 TABLET by mouth two times a day. Indication, Site, and Additional Prescription Instructions: half tab in a.m., one tab in p.m. International patient Topamax 50 mg tablet by mouth as directed by prescriber. Indication, Site, and Additional Prescription Instructions: Seizure one tab twice a day International patient ALLERGIES/ADVERSE REACTIONS Food : (FREE TEXT) ANIMAL HAIR - associated with eczema Other : RABBITS - associated with eczema Allergies above current as of Thursday, 05-Jul-2012 at 14:06. SYSTEMS REVIEW As noted in HPI. No history of fatigue, any history suggestive of any bone pain, any recurrent fevers. PAST MEDICAL/SURGICAL HISTORY As outlined in the HPI. SOCIAL HISTORY She is an only child. Father is a Greek history teacher at a university, and mom is a primary care teacher in a school in Cypress. FAMILY HISTORY No significant family history. VITAL SIGNS Height: 132.5 cm. Weight: 25.30 kg. BSA(G): 0.98 M2. BMI: 14.411 KG/M2. Temperature: 36.7 째C. (05-Jul-2012 14:05) Blood Pressure: 104/62 mmHg, left arm sitting. Pulse Rate: 112/minute. (05-Jul-2012 14:05)
PHYSICAL EXAMINATION General: The patient is alert, oriented, and in no acute distress. Skin: No rashes or skin lesions. Eyes: Pupils are equal, round, and reactive to light and accommodation. Extraocular movements are full. ENT: External canal and tympanic membranes are negative. Oropharynx is clear. Dentition good. No mucositis. Lymph: No cervical, axillary, supraclavicular, or inguinal lymph nodes palpable. Heart: Regular rate and rhythm. No murmurs noted. Lungs: Clear to auscultation bilaterally. Abdomen: Soft. No organomegaly. No masses felt. No tenderness. Extremities: Normal strength, bulk, and tone in upper and lower extremities. Neuro:deferred given detailed exam by Dr. Kodgal in Neurology.
This printout was generated through Patient Online Services and was the most current version as of the date and time generated.
Patient Copy Pediatric Hematology/Oncology 6-252-122 05-Jul-2012 14:05 Maria Foteini Kallimachou
Consult
Generated: 8-Jul-2012 10:07
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IMPRESSION/REPORT/PLAN #1 History of Dravet syndrome #2 History of elevated fetal hemoglobin Maria is a 10-year-old young girl who has been referred to our service given history of elevated hemoglobin F noted on hemoglobin electrophoresis done on the 6th of June at a level of 5.6, slightly decreased A2 at 1.9. I have reviewed her labs. Her lowest hemoglobin since 2007 has been 12.7. She has not shown any signs of anemia. Her MCV has always been high. She has always had macrocytosis. Her last platelets from last May was 140, and her ANC has ranged from 0.98 to 2.6. She has had ferritin levels done, which are normal. I have discussed with the family that, given her history and all the laboratory findings that I have at hand, I would think her elevated fetal hemoglobin is most likely secondary to her medications, especially her medications such as Depakene/ Depakote, and L-carnitine. I also did go over other possible causes for elevated fetal hemoglobin and discussed the same with the mother. She had multiple questions, which were all addressed. I will repeat a CBC and smear today and call family with the results. PATIENT EDUCATION Ready to learn. No apparent learning barriers were identified. Learning preferences include listening. Explained diagnosis and treatment plan; patient/family expressed understanding of the content. ADDENDUM Labs from today, CBC: Hemoglobin 13, platelet count 116, ANC 1.38. I called the mom and reviewed the results with her. I also requested the mom to discuss her thrombocytopenia and neutropenia with Dr. Kotagal and that they are most likely secondary to her antiseizure medications that she has been on for a while now. DIAGNOSES #1 Elevated fetal hemoglobin F Original: AAN:mle by aan Electronically Signed: 06-Jul-2012 18:53 by A.A. NageswaraRao, MBBS
This printout was generated through Patient Online Services and was the most current version as of the date and time generated.