课件：急性白血病病例报告.ppt

Acute Leukemia 097805 郑志博 Case: A male patient, 40 Years old, has associated with bleeding tendency for 10 days. He came to our department for diagnosis. Case: He had fever without obvious cause 10 days ago, 38.2℃, body aches, mild cough, a little white sputum, also found gums bleeding when brushing teeth, had abnormal blood test at local clinic (unclear). Anti-cold medicine without effort, poor sleep, urine and stool are normal, no obvious change in body weight History record Health, no history of tuberculosis (TB), no history of drug allergy. Not addicted to alcohol, tobacco, no similar family medical history Physical examnation T38.2℃，HR 98 per/min，RR 20 per/min，BP120/80mmHg Showed acute hot ill face, chest and lower limb skin had scattered bleeder, superficial lymph node untouched, sclera without stained yellow, pharyngeal hyperemia (+), tonsils(-). Sternal press pain, lung percussion naormal, right lung lower lobe had moist rales, abdomen flat soft, liver and spleen untouched under the rib, lower limbs are not swollen Laboratory tests Hb 95g/L，Ret 0.5%，WBC 3.8×109/L，Blasts 48%，PLT 30×109/L；urine (-), stool (-) Question (1) This case what is the most likely diagnosis? Diagnosis is based on what??(2) Describe the diseases with which cases should be identified? (3)What other tests should be used? (4) Describe the treatment of this case. Answers (1) diagnosis: Acute leukemia. Diagnosis is based on: fever, anemia, ，Blasts 48% 20%，PLT 30×109/L 60×109/L (2) This case need to identified with MDS, AA, ITP, IM, leukemoid reaction. (3)cytochemistry Immunological test, chromosome examination 　 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（PAS） （＋）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)This case treatment measures include: general treatment Chemical therapy: ALL: DV therapy, AML: DA, HA, HOAP therapy Bone marrow transpl