Amc 34yr old barber

AMC 4 th bed 34yr/M A 34 yr male barber by occupation came to the opd with chief complaints of giddiness and fall 3 days ago patient was apparently alright 5 years back in 2016- patient had jaundice,for which he used herbal medicine following which he had binge alcohol and severe loose stools,watery consistency (20 episodes/day) - for which he was admitted in outside hospital ,patient reports that he was in altered sensorium for 3 days in ICU during that admission (no records available).3 pints PRBC transfusion in ICU was done at that time of hospital stay.since discharge patient was fine and in 2018 patient went for regular check up ,he says blood investigations were normal at that time 3 days ago- patient c/o giddiness and fall in washroom with injury on left side of forehead ,then he went to a local RMP and on routine investigation was found to have pancytopenia and was referred here ,no h/o any ENT bleed , convulsions,LOC, blood loss during fall ,he complaints of generalised weakness since 1 month ,no c/o SOB ,body pains,joint pains,fever, bleeding gums,malena,hematemesis,vomitings,loose stools,pain abdomen,cough, tingling,numbness of limbs past history alcoholic since 15 yrs,drinks daily ,180-240 ml ,attenders report that whenever he gets free time ,he keeps on drinking alcohol and when he stops drinking alcohol for one day ,he reports craving and withdrawal symptoms (trmens).attendants complained that he drank alcohol even today before coming to hospital DM(-),HTN(-) personal history appetite- decreased since 5-6 months daily routine wakes up at 8 am,goes to barber shop for about 1-2 hrs,goes to bar beside his barber shop ,comes home eats little food and sleeps.after waking up again goes to barber shop for 2 hrs ,drinks alcohol and comes back home ,eats dinner and sleeps addictions- chews gutka 5-6 packets /day alcohol- since 15 yrs daily bowel movements- normal micturition - normal no significant family history general examination pallor-present icterus- present no clubbing,cyanosis, lymphadenopathy and edema pulse-120/min BP- 110/70 mmHg spo2 - 98% CVS s1,s2 heard RS : BAE + ,NVBS

Abdomen: soft,non tender CNS: NAD provisional diagnosis: Pancytopenia under evaluation treatment 1) inj.thiamine 100 mg in 100 ml/NS/BD 2) vitals monitoring 3)watchbfor bleeding manifestations,SOB 4)Tab.Lorazepam 2mg po/HS