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1、AcuteLeukemia097805郑志博Case:Amalepatient,40Yearsold,hasassociatedwithbleedingtendencyfor10days.Hecametoourdepartmentfordiagnosis.Case:Hehadfeverwithoutobviouscause10daysago,38.2℃,bodyaches,mildcough,alittlewhitesputum,alsofoundgumsbleedingwhenbrushingteeth,hadabnormalbloodtestatlocalclini
2、c(unclear).Anti-coldmedicinewithouteffort,poorsleep,urineandstoolarenormal,noobviouschangeinbodyweightHistoryrecordHealth,nohistoryoftuberculosis(TB),nohistoryofdrugallergy.Notaddictedtoalcohol,tobacco,nosimilarfamilymedicalhistoryPhysicalexamnationT38.2℃，HR98per/min，RR20per/min，BP120/80
3、mmHgShowedacutehotillface,chestandlowerlimbskinhadscatteredbleeder,superficiallymphnodeuntouched,sclerawithoutstainedyellow,pharyngealhyperemia(+),tonsils(-).Sternalpresspain,lungpercussionnaormal,rightlunglowerlobehadmoistrales,abdomenflatsoft,liverandspleenuntouchedundertherib,lowerlim
4、bsarenotswollenLaboratorytestsHb95g/L，Ret0.5%，WBC3.8×109/L，Blasts48%，PLT30×109/L；urine(-),stool(-)Question(1)Thiscasewhatisthemostlikelydiagnosis?Diagnosisisbasedonwhat? (2)Describethediseaseswithwhichcasesshouldbeidentified?(3)Whatothertestsshouldbeused?(4)Describethetreatmentofthisca
5、se.Answers(1)diagnosis:Acuteleukemia.Diagnosisisbasedon:fever,anemia,，Blasts48%>20%，PLT30×109/L<60×109/L(2)ThiscaseneedtoidentifiedwithMDS,AA,ITP,IM,leukemoidreaction.(3)cytochemistryImmunologicaltest,chromosomeexamination急淋急粒急单过氧化物酶（POX）（—）分化差的原始细胞（—）～（＋） 分化好的原始细胞（＋）～（＋＋＋）（—）～（＋）糖原反应（PA
6、S）（＋）成块或颗粒状弥漫性淡红色（—）/（＋）颗粒细而散在（—）/（＋）非特异性酯酶（NSE）（—）NaF抑制不敏感（—）/（＋）能被NaF抑制（—）/（＋）碱性磷酸酶（ALP/NAP）增加减少或（—）正常或增加(4)Thiscasetreatmentmeasuresinclude:generaltreatmentChemicaltherapy:ALL:DVtherapy,AML:DA,HA,HOAPtherapyBonemarrowtransplantationSupportivetherapy:Preventinfection,correctionanemia,c
7、ontrolhemorrhageandmaintainnutrition.Thankyouforlistening.
