mazo
30.11.2004, 17:56
The patient lays at me in chamber 3 days and I while at deadlock... BACKGROUND:
4 days ago in the general or common cardiology the patient of 65 years with clinic of an astable stenocardia (pressure behind a breast bone, gives to the left arm or hand, a scapula), a BP 140/80 acts,
Give Sodium nitritums, reduce a BP, remove or take out an electrocardiogram-there there is depression ST in V2-4 thoracal abductions - 1.5 mm, but without dynamics or changes within 8-9 hours, on an old electrocardiogram - is absolute as. Enzymes normal. The attack is stoped, the analysis of a blood - a hemoglobin 4.7 comes.
With it or this it or her translate to me in chamber in therapy.
In total after its or her occurrence in chamber::
The anamnesis: always on a life - a BP - 100-110/60-70, at rising up to 130-140 - clinic gipert. A crisis
In January of this year has caused or called fast on the next hypertonic crisis. The arrived doctor has lowered a BP, and has told or said, that she acyanotic, at it or her an anemia, and it is necessary to make the analysis of a blood. She has made, then for the first time has come to light HB - 4, for some reason in an out-patient department on it have not reacted. The same doctor with fast has told or said to drink iron and vit 12 - she has spent on drink itself a course of iron and has pierced vit 12, has handed over a blood - HB - 5.
It is more in this occasion it was not treated and it was not surveyed. Since then have sharply started to collapse or be blasted - to be crumbled a teeth - and 3 months ago, at excision of 5 teeth - there was longly proceeded bleeding from a box.
Never than did not hurt or be ill;be sick, operations were not, prof. Harmfulnesses are not present - manager. A warehouse., any preparations did not accept, bad habits denies.
At inspection: all soft and painless...
The lymphonodus on the right in inguinal area - 3*2 sm, motionless, painless is palpated.
Blood:
HB-4.6,
HT - 16 % (then 12 %),
Erythrocytes - 2.2,
Maintenance or Contents HB in an erythrocyte - I do not remember digit, but it is lowered,
Reticulocytes - 11 promile,
Color parameter 0.65,
Thrombocytes - 450 (In OTHER ANALYSIS - 188 - I SHALL not understand WHERE the MISTAKE or ERROR),
Lymphocytes - 20, all rest in norm or rate - is more... Singing are not present.
Leucocytes - 4000
In urine - norm or rate, fiber is not present.
It is spent:
Gastroscopy: atrofichnaja anemic mucous, 2 polyps - the biopsy is taken - is yet ready.
Colonoscopy - anything
US of organs of an abdominal cavity: a lien - 110*89*99 - the conclusion - a splenomegaly, (but, certainly it is not palpated). A liver neznachit. It is increased, homogeneous, etc.
steralnaja a puncture: - a punctate About-about-very or -very much poor or scanty - hardly, having displaced a needle, have pulled any quantity or amount of cells - therefore the answer inspires me doubts, but nevertheless - there is increased -in erythropoietic to-to, leukocytic - is suppressed, megacaryocytes - have not found out (?)
X-ray inspection - a thorax, flat bones (a basin, a skull), an abdominal cavity - anything.
The gynecologist, the urologist, the proctologist - anything.
- The program a minimum - I wait - for full biochemistry - with iron, OZHSS, fiber of all and on fractions - tomorrow will be. (while - jony, enzymes, a creatinine, urea - in norm or rate), coagulograms - too tomorrow will be.
- The program a maximum - a biopsy of that lymphonodus on Monday - but che I from it or her do not wait for anything... Inguinal..... But a splenomegaly...
While has started to receive -+.. All the same an anemia obviously iron deficiency
Surprises, that she thus not bad herself feels - delicacy... Sometimes govovokruzhenie...
Please... At whom will be ideas - I wait komentariev - for any I shall be grateful,
But here questions which spin:
1) cancer? Where?
2) it is simple ZHDA? - whether there can be she so expressed?
3) any aplastic anemia? A hypersplenism? - then like all cells should collapse or be blasted... Or it is unessential?
4) a leukosis? What?-
5) that else?
6) how still or even to survey... - - 3 days in hospital with the diagnosis *quot; an anemia not clear uN?N?a*quot;
4 days ago in the general or common cardiology the patient of 65 years with clinic of an astable stenocardia (pressure behind a breast bone, gives to the left arm or hand, a scapula), a BP 140/80 acts,
Give Sodium nitritums, reduce a BP, remove or take out an electrocardiogram-there there is depression ST in V2-4 thoracal abductions - 1.5 mm, but without dynamics or changes within 8-9 hours, on an old electrocardiogram - is absolute as. Enzymes normal. The attack is stoped, the analysis of a blood - a hemoglobin 4.7 comes.
With it or this it or her translate to me in chamber in therapy.
In total after its or her occurrence in chamber::
The anamnesis: always on a life - a BP - 100-110/60-70, at rising up to 130-140 - clinic gipert. A crisis
In January of this year has caused or called fast on the next hypertonic crisis. The arrived doctor has lowered a BP, and has told or said, that she acyanotic, at it or her an anemia, and it is necessary to make the analysis of a blood. She has made, then for the first time has come to light HB - 4, for some reason in an out-patient department on it have not reacted. The same doctor with fast has told or said to drink iron and vit 12 - she has spent on drink itself a course of iron and has pierced vit 12, has handed over a blood - HB - 5.
It is more in this occasion it was not treated and it was not surveyed. Since then have sharply started to collapse or be blasted - to be crumbled a teeth - and 3 months ago, at excision of 5 teeth - there was longly proceeded bleeding from a box.
Never than did not hurt or be ill;be sick, operations were not, prof. Harmfulnesses are not present - manager. A warehouse., any preparations did not accept, bad habits denies.
At inspection: all soft and painless...
The lymphonodus on the right in inguinal area - 3*2 sm, motionless, painless is palpated.
Blood:
HB-4.6,
HT - 16 % (then 12 %),
Erythrocytes - 2.2,
Maintenance or Contents HB in an erythrocyte - I do not remember digit, but it is lowered,
Reticulocytes - 11 promile,
Color parameter 0.65,
Thrombocytes - 450 (In OTHER ANALYSIS - 188 - I SHALL not understand WHERE the MISTAKE or ERROR),
Lymphocytes - 20, all rest in norm or rate - is more... Singing are not present.
Leucocytes - 4000
In urine - norm or rate, fiber is not present.
It is spent:
Gastroscopy: atrofichnaja anemic mucous, 2 polyps - the biopsy is taken - is yet ready.
Colonoscopy - anything
US of organs of an abdominal cavity: a lien - 110*89*99 - the conclusion - a splenomegaly, (but, certainly it is not palpated). A liver neznachit. It is increased, homogeneous, etc.
steralnaja a puncture: - a punctate About-about-very or -very much poor or scanty - hardly, having displaced a needle, have pulled any quantity or amount of cells - therefore the answer inspires me doubts, but nevertheless - there is increased -in erythropoietic to-to, leukocytic - is suppressed, megacaryocytes - have not found out (?)
X-ray inspection - a thorax, flat bones (a basin, a skull), an abdominal cavity - anything.
The gynecologist, the urologist, the proctologist - anything.
- The program a minimum - I wait - for full biochemistry - with iron, OZHSS, fiber of all and on fractions - tomorrow will be. (while - jony, enzymes, a creatinine, urea - in norm or rate), coagulograms - too tomorrow will be.
- The program a maximum - a biopsy of that lymphonodus on Monday - but che I from it or her do not wait for anything... Inguinal..... But a splenomegaly...
While has started to receive -+.. All the same an anemia obviously iron deficiency
Surprises, that she thus not bad herself feels - delicacy... Sometimes govovokruzhenie...
Please... At whom will be ideas - I wait komentariev - for any I shall be grateful,
But here questions which spin:
1) cancer? Where?
2) it is simple ZHDA? - whether there can be she so expressed?
3) any aplastic anemia? A hypersplenism? - then like all cells should collapse or be blasted... Or it is unessential?
4) a leukosis? What?-
5) that else?
6) how still or even to survey... - - 3 days in hospital with the diagnosis *quot; an anemia not clear uN?N?a*quot;