### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My mother has been on hemodialysis for the last 2 years. The consistent feature was that her hemoglobin levels never went past 7 mg dl for 2 years despite erythropoietin injections. She has had anaphylactic reactions to oasis, penicillin and aspirin in 2011; she has had chronic leg and foot edema Since her aspirin allergy. In feb 2012 , she had chills and fever and sudden abdominal pain and distension- initially thought as peritonitis, but diagnosed later as rectus sheath hematoma; last 3 weeks she developed sudden pancytopenia with platelets dropping to 0000; she was transfused 2 whole units of blood; some reversal of hematocrit has happened; heparin has been stopped; she has seen a hematologist and had a bone marrow biopsy done ; currently awaiting test results; for the last one week, she has had alternating fever, chills and weakness ( currently awaiting blood culture results to see if there s post biopsy infection) and also excessive++ night sweats ,mostly after dialysis. I am wondering about the likely causes of her sudden drop in blood values, the reason for the persistent leg edema ( not classical pitting edema; has not changed much with dialysis; nephrologist not sure if allergic or chronic) and the reason for the night sweats Any recommendations tests or Rx wise Thank you kindly

### output:

Hi Ashwin, Thanks for writing in. The sudden pancytopenia in your mother can be due to a arbovirus infection. This is a viral infection which can cause a sudden plastic crisis. The night sweats, fever and chills can be due to sepsis or infection in the blood stream.  She would be particularly susceptible to these as her white blood cells (which fight infections) are low. The persistent edema is more likely to be due to chronic kidney disease and would only decrease when the blood counts start improving. You should actively consider renal transplant as an option as the survival is improved in patients with renal transplants as compared to patients with dialysis.