slide anemia aplastik
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Aplastic
Anemia
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Defnition
•Pancytopenia resulting from aplasithe bone marrow
•classied into primary and secondatypes.
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Defnition
• the bone marrowproduces too fewof all three types
of blood cells: redcells, white cells,and platelets(pancytopenia)
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Causes
• A -Primary:
1- congenital (as Fanconis anem
!- "diopathic ac#uired ($%& ofcases).
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Causes
• '- secondary:
1-chemicals (benene, toluene, glue !-drugs (chemotherapeutics, antibiophenytoin). *-insecticides. +-ioniing radiation. -infections (as hepatitis). $-paraysmal nocturnal haemoglobi
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Pathophysiology
eduction in the number of haemopoietic pluripstem cells
-------/ fault in the remaining stem cells
0
"mmune reaction against stem cells.
-------/ unable to diide and di2erentiate sucieproduce the blood cells.
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Clinical Features
• 3nemia with malaise, pale, and otherassociated symptoms such as palpitatio
• 4hrombocytopenia (low platelet counts)leading to increased ris5 of hemorrhagebruising and petechiae.
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Clinical Features
•
6eu5openia (low white blood cell count),leading to increased ris5 of infection.
• eticulocytopenia (low reticulocyte coun
• 0ccurs at any age.
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Diagnosis
• 1- 7omplete 'loodPicture (7'P): whichshows pancytopeniaand reticulocytes.
• !-'one marrow
aspirate: 8ar5edlyhypocellular marrow,due to replacementof hemopoieticmarrow by adipose
tissue (not brosis or
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4o dene aplastic anemia there must be at least two of thefollowing :!
•)i(haemoglobin <10 g/dL
•)ii(platelet count 9 1;<mm;
•)iii(neutrophil count <1,5 x 10/l(.
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THERAPY
1-General:
• 4he cause is remoed.
• =upportie care with blood 4ransfusion,
concentrate.
• Preention of infection.
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THERAPY
2. Specifc: 3-'0?@ 830A 43?=P63?434"0?:
• 4reatment of choice.
• from B63 matcheddonor. Csually siblings.
• 6ong term surialrates: $-%&.
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THERAPY
3-"88C?0=CPP@=="0?: by using drugs
• 3ntithymocyte globulin (34D)
• 3ntilymphocyte glubulin (36D)
• 7yclosporin
• "ntensie immunosupression : cyclophospham
• 7orticosteroids.
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CASE REPORTObecti!eThe obecti!e o" this paper is to report a case year ol$ boy %ith a $iagnosis o" aplastic anem.
DP, a E year old boy, with 1 5gcm of 'B, came to Bai 3damBospital 8edan on 11th ?oe
1$.. Bis chief com.
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History o" $isease:
DP, a E years $ months old boy, with 1 5g of 'A and 11! cmto Bai 3dam 8ali5 Deneral Bospital 8edan on 11th ?oembewith pale as chief complaint. 4he patients hae been eperie
! days before admitted to hospital.Petechie (-), hematoma (G) on the arms and legs, blac5epistais (-). Bistory of spontaneous bleeding (G) on thedays ago while feer.
Feer has been eperienced by patient since * days ago
temperature rises and drop, and was decreased by anti=hiering was not found. =eiure was not found.
Patient also eperienced malaise since ! days ago.
7yanosis (-), omiting (-) and nausea (-). Hefecation and urinormal. Bistory of weight loose is not found.
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History o"pre!iousillness& Be had been
hospitalied in Bai
3dam 8ali5hospital on 3ugustand 0ctober !1
for transfusion.
History o"me$ic'ation&
3nti-pyretic drug
P7 transfusion on3ugust and0ctober !1
History o""amily&
4here is no famiyhistory of similar
disease found
Hp
m
yp
reco
o
ma7
he
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Historyo"parent(sme$ic'
ation:?ot found
History o"birth&
Patient was rst child.Destational age wasaterm (*$ wee5s).
'ody weight was !Egram, body length was
not measured. 'irth
was assisted by doctor.'aby was born
normally and criedspontaneously. 'lusih
was not found.
Historyo"
immuni)ation&?ot complete
H
$
P
egrw
ba
Ph i i b d
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PhysicalE*ami
nation
Presentstatus&
=ensorium : 78, body temper
B: 1 bpm, : !! <i,
'A: 1 5g, 'B: 11! cm, 'A<3'6<3: K score 9 -*, 'A<'6: K s
anemic (G), icteric (-), dyspne
(-), edema (-)
+ocali)e$status&
Bead : Face: pale
@yes : light reLe G<G, isochopupil, pale inferior palpebral
conunctia G<G, superior andpalpebra edema-<-
@ars<?ose<8outh : within normrange
?ec5 : MNP -!cmB!0 lymph n
enlargement (-)
4hora : =ymmetrical fusifor-
Ph i l : !!<i regular ronchi (G<G) wheeing ( <
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PhysicalExamination
: !!<i, regular, ronchi (G<G), wheeing (-<
3bdomen: =ymmetric, supple, normal peristspleen: normal
@tremities : pulse 1 bpm regular, ade#ua
warm, 74 9 *O
Di,erentialDiagnosi
s&
3plastic anemia G 3=H
3leu5emic leu5emia G 3=H
"mmune 4rombositopenia Purpura G 3=H
-or.ing$iagnosis:
3plastic anemiaG3=H
Th P7 4ransfusion (need !1 cc)
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Therapy : P7 4ransfusion (need !1 cc)
4rombosit 4ransfusion ! unit
Diagnosti
cPlanning&
7omplete blood analysis
adiology eamination
@cho eamination
+aboratory fn$ing
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Test Result Unit
Hemoglobin 8.40 g%
Erythrocyte 2.50 106/mm3
Leucocyte 5.13 103/mm3
Thrombocyte 5 103/mm3
Hem!tocrite 24.20 %
Eo"ino#hil 1.00 % $!"o#hil 0.500 %
eutro#hil 2.80 %
+aboratory fn$ingComplete bloo$ analysis /00th 1o!ember2304 5 067338
T t R lt U it
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Test Result Unit
Lym#hocyte 65.70 %
&onocyte 3.30 %
eutro#hil !b"olute 1.53 103/(L
Lym#hocyte !b"olute 3.37 103/(L
&onocyte !b"olute 0.17 103/(L
Eo"ino#hil !b"olute 0.05 103/(L
$!"o#hil !b"olute 0.01 103/(L
&)* 6.80 +l
&)H 33.60 ,g
&)H) 34.70 g%
Result& Anemia normo.rom normositer 9 Trombositope
Ra$iology e*amination
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Result:
'oth of sinus costophrenicus are sharp. Hiafragma is smooth, ?o inltrate, 7ardiomegaly 4rachea in middle, 'ones and soft tissue normal
Ra$iology e*amination
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•6arge 3=H (1-!mm)
•"nade#uate right posterior
•is5 sided enlargement
Result o" Echo e*amination
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S
O en"orium )& Tem# 37)
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#eb-/-
E!r
o"e
&outh
Thor! "ymmet-
H< 8 b-
<< 22/i regul!r r-/-
>bomen "u##le #eri"t!ltic 9 Lier !n
Etremitie" #ul"e 8 b#m regul!r !e?u!te #/ A
A
P ,<) Tr!n"u"i
Answer from H
S
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S
O e
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#-/-
E!
o"
&out
Thor! "ymm-
H< 10-
<< 24/i regul!r-/-
>bomen "u##le #eri"t!ltic 9 Lier !
Etremitie" #ul"e 104 b#m regul!r !e?u!te #A
A
P ,<) Tr!n"u"ion C
Trombo"i
S
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S
O en"orium )& Tem# 368)
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#e-/-
E!r
o"e
&outh
Thor! "ymme-
H< 4-
<< 20/i regul!r -/-
>bomen "u##le #eri"t!ltic 9 Lier !nEtremitie" #ul"e 4 b#m regul!r !e?u!te #/A
A
P
Biet &$
Answer from He
S
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S
O en"
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#eb-/-
E!r
o"e
&outh
Thor! "ymmet-
H< 2b-
<< 22/i regul!r r-/-
>bomen "u##le #eri"t!ltic 9 Lier !n
Etremitie" #ul"e 2 b#m regul!r !e?u!te #/ A
A
R )om#let
+aboratory fn$ing
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Test Result Unit
Hemoglobin 11.30 g%
Erythrocyte 3.56 106/mm3
Leucocyte 2.27 103/mm3
Thrombocyte 13 103/mm3
Hem!tocrite 33.20 %
Eo"ino#hil 0.40 %
$!"o#hil 0.400 %
eutro#hil 6.60 %
Lym#hocyte 25.60 %
&onocyte 4.00 %
y g Complete bloo$ analysis /0:th 1o!ember 5 0073#8
Test Result Unit
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eutro#hil !b"olute 1.58 103/(L
Lym#hocyte !b"olute 0.58 103/(L
&onocyte !b"olute 0.0 103/(L
Eo"ino#hil !b"olute 0.01 103
/(L $!"o#hil !b"olute 0.01 103/(L
&)* 3.30 +l
&)H 31.70 ,g
&)H) 34.00 g%
+erritin 727.30 ng/ml
Result& +eu.openia 9 Trombositopenia
S 9
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S 9
O en"orium )& Tem# 368)
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#eb-/-
E!r
o"e
&outh
Thor! "ymme-
H< 8-
<< 24/i regul!r -/-
>bomen "u##le #eri"t!ltic 9 Lier !n
Etremitie" #ul"e 8 b#m regul!r !e?u!te #/A
A
P
Biet &$
S 9
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S 9
O en
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#eb-/-
E!r
o"e
&outh
Thor! "ymme-
H< 100 -
<< 25/i regul!r -/-
>bomen "u##le #eri"t!ltic 9 Lier !n
Etremitie" #ul"e 100 b#m regul!r !e?u!te #/A
A
P
Biet &$
+aboratory fn$ingC l t bl $ l i /0:th 1 b
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Test Result Unit
Hemoglobin 11.30 g%
Erythrocyte 3.42 106/mm3
Leucocyte 3.20 103/mm3
Thrombocyte 21 103/mm3
Hem!tocrite 32.50 %
Eo"ino#hil 1.30 %
$!"o#hil 2.800 %
eutro#hil 21.20 %
Lym#hocyte 68.10 %
&onocyte 6.60 %
Complete bloo$ analysis /0:th 1o!ember 5 0073#8
Test Result Unit
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eutro#hil !b"olute 0.68 103/(L
Lym#hocyte !b"olute 2.18 103/(L
&onocyte !b"olute 0.21 103/(L
Eo"ino#hil !b"olute 0.04 103/(L
$!"o#hil !b"olute 0.0 103/(L
&)* 5.00 +l
&)H 33.00 ,g
&)H) 34.80 g%
Result& ;isitopenia
S 9
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O en"orium )& Tem# 368)
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#eb-/-
E!r
o"e
&outh
Thor! "ymme-
H< 6-
<< 24/i regul!r -/-
>bomen "u##le #eri"t!ltic 9 Lier !n
Etremitie" #ul"e 6 b#m regul!r !e?u!te #/A
A
P
Biet &$
S 9
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O en"o
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#eb-/-
E!r
o"e
&outh
Thor! "ymme-
H< 6-
<< 24/i regul!r -/-
>bomen "u##le #eri"t!ltic 9 Lier !n
Etremitie" #ul"e 100 b#m regul!r !e?u!te #/A
A
P
Biet &$
S
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O en"orium )& Tem# 368)
Eye Light rele 9/9 i"ochoric #u#il #!le inerior con:uncti! #!l#e-/-
E!r
o"e&outh
Thor! "ymme-
H< 6-
<< 20/i regul!r -/-
>bomen "u##le #eri"t!ltic 9 Lier !n
Etremitie" #ul"e 6 b#m regul!r !e?u!te #/A
A
P
Biet &$
R
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- Farana Qhairunisa
- 3nanda Putri 4arigan