History of Present Illness 6 years prior to current admission (2006), the patient manifested a progression of signs and symptoms

initially starting with malaise, decreased appetite and generalized jaundice and pallor. Patient had undocumented fever for two days, concurrently experienced with non-productive cough, shortness of breath and an episode of epistaxis. Patient sought medical consultation and was later admitted at Western Visayas Medical Center where she was diagnosed with Anemia and transfused with 2 units of PRBC. She stayed in the institution for approximately 2 weeks and was discharged with an improved condition. Following the discharge from 2006 to 2010, patient sought routine follow-up check-ups at the Outpatient Department of Western Visayas Medical Center, usually once every two months. She has also been given Multivitamins 5ml to be taken OD as supplementary management. However, within these years, she still experienced at least two episodes of cough and flu which were treated with Dextromethorphan HBr 2.5mg/0.8mL, and Pseudoephedrine HCl 7.5mg/0.8mL (Dimetapp) 1.5 ml every 6 hours and Co-amoxiclav 400/57 mg in 5 mL TID as prescribed. 2 years prior to current admission (2010), the patient again manifested similar progression of signs and symptoms beginning with malaise, decreased appetite, jaundice, pallor, fever, non-productive cough, shortness of breath and an episode of epistaxis. She was then brought to Western Visayas Medical Center for consultation and later on, admission. During her hospitalization, she was diagnosed with Thalassemia and was again transfused with 2 units of PRBC. Her course in the ward was towards and improving state and in two weeks time she was discharged. Part of her discharge planning was an advice to always wear mask and avoid public places. She was also told not to engage in strenuous physical activities and have a monthly check-up at the Out-patient department of Western Visayas Medical Center. She continued her Multivitamins 5ml OD as supplementary management. Following the discharge from 2010 to 2011, patient observed regular monthly check-ups. However, she exhibited the same pattern as every year she experienced at least two bouts of flu and cough which was treated by the same abovementioned medications, Dimetapp and Co-amoxclav. She was also reported to have not complied with the health teaching of wearing mask often when out in the open and she continued to play extensively with her peers after class to the point of experiencing shortness of breath which was later on relieved by rest. One year prior to current admission (2011), the patient, for the third time, displayed the same progression of signs and symptoms: malaise, decreased appetite, fever, jaundice, pallor, non-productive cough, shortness of breath and an episode of epistaxis. She was brought to Western Visayas Medical Center and was admitted with the same diagnosis of Thalassemia. It is during this hospitalization that she was found out, through an ultrasonography report, to have splenomegaly. Her prognosis was the same as her previous admissions and after another 2 blood transfusions of PRBC; she was discharged in an improved condition. For several months, she did not have any reports of discomfort and weakness except for the episodic shortness of breath following playtime. She was still non-compliant with the wearing of the mask and limitation of physical activity but was regular in taking her Multivitamins. Her non-compliance to the advice of limiting physical activity was attested to by her minor sprain injury (5 months prior to current admission) in her left foot during playtime because she running haphazardly. It was relieved by rest and traditional hilot management.

3 months prior to current admission (March 13, 2012), for the fourth time around, the patient manifested the same pattern of signs and symptoms: malaise, decreased appetite, fever, jaundice, pallor, non-productive cough, shortness of breath and an episode of epistaxis. Once again, she was brought to and admitted at Western Visayas Medical Center for management. She was transfused with two units of PRBC and after recuperation was sent home after 10 days (March 23, 2011) in an improved condition. The same pattern of discharge planning and implementation was observed. A week prior to current admission (June 11, 2012), after returning home from school, patient complained of generalized weakness. Patient was not able to consume regular amount of meals and was noted to have decreasing appetite. A day after, (June 12, 2012), she started to look pale and the abovementioned signs and symptoms persisted. Patient continued to go to school the next few days but still had the same complaints. Three days prior to admission, (June 16, 2012), she had a fever of 37.9C per axilla. She was then treated with paracetamol 120mg/5ml 10 ml every six hours. Her fever however, persisted ranging from 37.8 38.5 C per axilla. Two days prior to current admission, (June 17, 2012), she began to manifest jaundice more prominently seen in her skin. She also developed a non-productive cough and episodes of shortness of breath relieved by deep breathing and sitting up straight. A day prior to current admission, (June 18, 2012), the abovementioned signs and symptoms persisted. On the night of the same day, patient experienced an episode of epistaxis which was later relieved by direct pressure on the nasal area and rest. On the day of current admission, (June 19, 2012), patient with the persisting signs and symptoms, together with her folks decided to seek medical consultation at Western Visayas Medical Center. She was assessed and advised for hospitalization. Thus, this admission.