Download - Case - Dr. Irwin (Anemia Aplastik)
Aplastic Anemia
ANITA ANGGITIA PERMANA
CO-ASSISTANT
IDENTITY
Name : Mr. EAge : 47 yearsGender : MenAdress : Citaman, KarawangOccupation : Labour Religion : MoslemMarital status : MarriedRace : SundaneseEducation : Junior High School
Admisson to hospital at 23th October 2012
ANAMNESE
Autoanamnese
on 23th October 2012 at 12.00
History of present disease
Patient came to RSUD Karawang with complaint immense Weakness with palpitations and fatigue since 4 days before admitted to hospital. His breathing was very fast which was worsened by walking fast, climbing stairs, and by any kind of exertion. He also got dizzy when he stand up from sitting or squatting.
He felt nausea and vomited when the dizziness attacks. he wasn’t felt that the environment is moving or spinning, and when the dizziness attacks he haven’t felt hearing ringing or buzzing on his ears. His appetite was markedly less. There’s no body weight loss, He also complained of paleness of lips and hands for the past 3 months. Fever , cough denied by him.
History of present disease
History of present disease
• Patient never had history of nose bleed,gum bleed, and swelling in both of lower extremities.He also complained of tingles in the legs for the past 6 months but He haven’t feel burning and pain too in his legs. He has noticed that, in the past 6 month, she is increasingly thirsty. he gets up several times a night to urinate, and finds herself gulping down glassfulls of water. Itchies on skin denied
History of past disease
He was hospitalized twice for the same complaint on October, September 2012
Past medical history
Family history
• No one in his family got a symptom or disease like him• Hypertension (-), Liver disease (-), Kidney disease (-),
Cancer (-), Diabetes Mellitus (-), heart disease (-)
• Eat three times a day• Sweet tea 4-5 cups/day since he was young • Smoking 1packs for 2 days• Eat “jeroan” almost everyday since he was young • Drugs (-), Alcohol (-) coffee (-)• Tatoo (-)
HABIT HISTORY
PHYSICAL EXAMINATION
Picture of patient
General condition
THORAX HEART
Inspection : Symmetrical Palpation : Equal vocal resonancePercussion : Sonor in both lungsAuscultatiom : Vesicular breath sound in
both lung,ronchi (-/-),
wheezing (-/-)
THORAXLUNG
• INSPECTION– brown skin, flat, supple– Icteric (-) ,pale (-) hematom (-) ptechie(-)
• AUSCULTATION– Bowel sound (+) normal 2x/minute , venous hum (-), – arterial bruit (-)
• PERCUSSION– Tymphany in all abdomen regio
• PALPATION– turgor normal – Hepatomegali (-), splenomegali (-)
ABDOMEN
Warm acral
Edema
Deformation (-), brown skin , icteric (-), flapping tremor (-), palmar eritema (-), pale nails(+)
EXTREMITY
Haematology Result NormalHemoglobin 5,1 12-17 gr/dL
Eritrocite 3.8 – 5.8 jt/mm2
Leukocytes 1900 5.000 – 10.000
Trombocytes 25.000 150.000 – 450.000
Hematocrite 15 37-43%
Diff. Count :
- Basofil 0 0-1
- Eusinofil 0 1-3
- Batang 0 2-6
- Segmen 25 40-70
- Limfosit 70 20-40
- Monosit 5 2-8
LABORATORY23. 10. 2012
LABORATORY
Result Normal GDS / reduksj 295 80-140 mg/dl
GDN 70-100 mg/dl
GDPP <140 mg/dl
Ureum 16,1 10-45 mg/dl
Creatinin 1,03 0,4-1,5 mg/dl
MCV 84 82-92 mc/L
MCH 26 27-31 Pg
MCHC 32 32-35 %
RDW 13,2 12,8±1,2 %
24. 10. 2012
Haematology Result NormalHemoglobin 6,5 12-17 gr/dL
Eritrocite 2,4 3.8 – 5.8 jt/mm2
Leukocytes 2700 5.000 – 10.000
Trombocytes 8000 150.000 – 450.000
Hematocrite 21 37-43%
Reticulocytes 0,8 0,5-1,5 %
24. 10. 2012
Kimia darah Result Normal GDS / reduksj 285 80-140 mg/dl
GDN 405 70-100 mg/dl
GDPP 510 <140 mg/dl
Ureum 10-45 mg/dl
Creatinin 0,4-1,5 mg/dl
Cholesterol 205 <200 mg/dl
Total Bilirubin 0,70 <1,1 mg/dl
Direct bilirubin 0,18 <0,6 mg/dl
Indirect bilirubin 0,52 <0,5 mg/dl
25. 10. 2012
Haematology Result NormalHemoglobin 7,0 12-17 gr/dL
Eritrocite 3.8 – 5.8 jt/mm2
Leukocytes 2100 5.000 – 10.000
Trombocytes 7000 150.000 – 450.000
Hematocrite 20 37-43%
Reticulocytes 0,5-1,5 %
MCV 82-92 mc/L
MCH 27-31 Pg
MCHC 32-35 %
RDW 12,8±1,2 %
Peripheral Blood Smear
• Eritrocytes : normositic normocrom anisopoikilocitosis
• Leucocytes : decrease, there is no morphology abnormalities
• Trombocytes : decrease, trombocytes group
is negative, Giant trombocytes
is negative
Descripsition : Pansitopenia
23.10.2012 24.10.2012 25.10.20125,1 6,5 7,0
23.10.2012 24.10.2012 25.10.20121900 2700 2100
23.10.2012 24.10.2012 25.10.201225.000 8000 7000
Hemoglobin
Leukocytes
Trombocytes
RESUME
Blood pressure100/60MmHg
Heart rate88 x/min
Respiration rate18 x/min
Temperature36,2 C
Anemic conjungtiva +/+
Pale lip (+)
Pale nails (+)
No pitiing oedem in lower extremities
Anemia
Leukocitopenia
Trombocitopenia
Eritrocytes : Hipocrome anisopoikilocitosis
(ovalocytes, microcytes )
GDS 295 mg/dl
GDN 405 mg/dl
GDPP 510 mg/dl
American Association of Clinical Endocrinologist - 2011 (AACE-2011)
• FPG > 126 mg/dl, fasting means no caloric intake > 8 hours, or
• 2-h PG > 200 mg/dl after 75 g oral glucose load in the morning after an overnight fast of at least 8 hours, or
• Symptoms of uncontrolled hyperglycemia (e.g polyuria, polydipsia, polyphagia) and a random (casual, nonfasting) plasma glucose concentration > 200 mg/dl
DIFFERENTIAL DIAGNOSISMyelodisplasia hiposelular
Leukimia limfositik granular
Anemia aplastic and Nocturnal Paroksismal Hemoglobinuria
Anemia Hemolitik
Herediter Aplastic Anemia
Anemia with Idiopatic Trombocytopenia Purpura
Anemia e.c Viral infection
Anemia Aplastic e.c Drugs Induce (Cloramphenicol. Etc)
Treatments
• Pharmacology– Nacl 0,9 % 20 dpm– Methyl prednisolon
125mg 2 x 1– Lanzoprazole 1 x 1– Sangobion 2 x 1– Metformin 500 mg – PRC transfution
• Non pharmacology– Resting when he need to– Avoiding contact sports– Self - Protecting from germs– diet DM
KH : 60-70%
Protein : 10-15%
lipid : 20-25%
- Exercise continously,rhytmical,interval,progresisve 3-4 x/day
Suggested Treatments
Bone marrow stimulant (sagramostim, figrastim. Epoitin , etc)
• Trombocytes transfution
Suggested examination
•Bone marrow biopsy
PROGNOSIS
• Ad Vitam : Dubia ad Malam
• Ad Fungsionam : Dubia ad Malam
• Ad Sanasionam : Dubia ad Malam
ANITA ANGGITIA PERMANA
Presented by :
Anemia Aplastik
Bone marrow transplantatio
n
Imunosupresive therapy respons
Decrease CSA on 6 month Repeat ATG /ALG
Repeat munnosupresive
therapyFollow up
Hemapoietic growth factors
Age >35 yr orHLA not matched
Age >35 yr orHLA matched
No respon
No respon
Respon +
Respon +
Relaps + Relaps --