CASE-Anemia Hipoplasi.doc
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HYPOPLASTIC ANEMIA
Definition
Hypoplastic anemia is condition with decrease of erytrocyte, leucocyte and
trombocyte that caused by depression of bone marrow.
Etiology
a. Genetic factor
b. Drug and chemis material
It caused by hypersensitivitas or over dosis of drug : Chloramfenicol,
benzene, busulvan, cyclophosfamid.
c. Infection : hepatitis virus non A-nonB
d. Radiation
e. Immunologys
f. Anemia aplastic on other diseases
g. Idiopatic
Pathogenesis
There is no single pathogenetic mechanism in hypoplastic anemia. Stem cell
differentiated to erytropoetic, granulopoetic, trombopoetic, limpopoetic. The other
stem cell crack by active to new stem cell. Half of stem cell on dormant that can
differentiated to variety of system of hemopoetic.
Causes of Heart Failure
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It is importan not only to identify the underlying cause of heart disease, but
also the presipitating causes of it. Clinical manifestation of heart failure appear of
the first time in course of some acute disturbance that place additional load on
myocardium that chronically is excessive burdened. The presipitating caused are:
1. Infection
2. Anemia
3. Thyrotoxicosis and pregnancy
4. Arythmias
5. Rheumatic and other forms of myocarditis
6. Infective endocarditis
7. Physical,dietary, fluid, environmental,and emotional excesses
8. Sistemic hypertension
9. Myocardial infarction
10. Pulmonary embolism
Pathophysiology
Early in the various heart diseases, the conpensatory mechanism are adequate
to maintain a normal cardiac output and normal intracardiac pressure at rest and after
exercise. Hypertrophy may be recognized by physical examination
,electrocardiography, or echocardiography, and when ventricular dilatation occurs,
cardiac enlargement can be seen on the plain chest film. Compensated heart disease
becomes decompensated as ventricular volume and filling pressures of the
respective ventricle increases. This is known as diastolic dysfunction and can be the
primary cause of increased left ventricular filling pressure and pulmonary congestive
heart failure. Diastolic dysfunction is particularly common in elderly patients with
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hypertention and in patients with myocardial ischaemia due to the coronary heart
disease.
As the filling pressure increases, hydrostatic pressure exceeds colloid osmotic
pressure at the capillary level, and pulmonary venous congestion occurs. When the
limphatics can no longer adequately remove the excess fluid, interstitial and then
alveolar edema of the lung occurs, resulting in symptoms of left ventricular failure
with dyspnea, exertional cough, orthopnea, paroxysmal nocturnal dyspnea, and
pulmonary edema,. Raised venous pressure, hepatomegaly, dependent edema, and
ascites occur when failure involves the right ventricle.
Clinical Findings
Treatment
1. Transfusi
2. Kotikosteroid
3. Transplantation of bone marrow
4. Imunosupresive
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CASE REPORT
A male patient aged 36 years old was admitted to Internal Medicine
Department of RSUP Dr. M. Djamil Padang on December 3th, 2003 with:
Chief complain: Bleeding of gynggiva since 5 days before admitted in hospital
Present illness history:
Bleeding of gynggiva since 5 days before admitted in hospital, 3 glasses a
day
Bleeding of gynggiva was not causing by trauma
Bleeding gynggiva was often since 9 months ago, not too much
There is no bleeding on the other of body.
Fatique ,dizzy since 9 months ago, the patien cannot work normally.
Pale since 9 months ago.
Fever since 0ne month, not continue, not shivering, not sweating, not high
Appetite decreased since he got ill.
Nausea (-), vomite (-)
Mixturation and defecation were normal.
Previous illness history:
The patient never get typhus
The patient never get hepatitis
The patient never get radiation
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The patient never get drugs in long time
Familial Illness History:
His nephew get bleeding diseases and BMP positif (pastway)
Occupation and Socials Economics History:
- Farmer
Physical Examination
Vital Sign:
- General appearance : Moderetely ill
- level of consciousness : Composmentis cooperative
- blood pressure : 120/60 mmHg
- pulse rate : 99 x/menit
- respiratory : 28x/menit
- temperature : 38 0C
- cyanosis : (-)
- general edema : (-)
Skin:
- colour : brown,pale
- palpable temperature: febris
- icteric : (-)
- edema : (-)
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Lymph node : no enlargement
Head:
- Eye: conjungtiva was anemic, sclera was not ikteric
- Mouth : gynggiva was bleeding
Neck:
- Pharinx: no disturbance
- JVP : 5 -2 cmH2O
- No enlargement of lymph nodes and thyroid gland
- Tonsil : no enlargement
Chest :Normochest
Lungs:
Inspection :Symetric on static and dynamic. Respiratory tipe :
Thoracoabdominal
Palpation : Fremitus was the same on the right and left side
Percussion : Sonor both of lung
Auscultation : Vesikuler N, wheezing -, rales -
Heart:
Inspection : ictus was not visible
Palpation : ictus was palpable one finger medial of linea midclavicularis
sinistra 5 Th ICS
Percussion : Left: one fingers medial of LMCS 5 Th ICS
Right: Linea sternalis dextra
Upper: 2nd
ICS
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Auscultation : Pure, Reguller, M1>M2, A2>P2, murmur -, gallop -
Abdomen:
Inspection : no enlargement
Palpation : liver and spleen not palpable
Ballotement (-)
Percussion : timpany, shifting dullness (-)
Auscultation : peristaltic sound was normal
Back:
Inspection: simetric.
Palpation : pressure pain of Murphy angle (-)
Percution : Knock pressure of CVA (-)
Extrimities:
- physiological reflex : +/+ normal
- patologycal reflex : -/- normal
- swollen legs : (-)
- tremor : (-)
- sianotic fingers : (-)
- edema : (-)
Laboratory Finding (LF)
Blood : Hb : 2,7 gr%
Leucocyte : 1200/mm3
Trombosyte : 16.000/mm
Working Diagnosis:
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- Anemia Normocytic Normocrom ec Hypoplastic ec Idiopatic
Differencial Diagnosis
Anemia Normocytic normocrom ec Hypoplasia ec insecticide
Therapy:
- Bedrest, smooth food, high calories high protein
-IVFD NaCl 0,9 %
- Transfusi Trombosite
- Transfusi PRC
- Transamin 3x1
- Vit K 3x1
-Vit C 3x1
Planning examination:
- BMP
- Faal Hemostatic
FOLLOW UP
December 4rd 2003
A/: -fever (-)
- fatique (+)
- appetite decreased
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- Bleeding gynggiva (-)
PE/:- GA Conc BP PR RR T
Moderately ill Cmc 100/60 102x/i 24x/i 36,80 C
Eye : Conjungtiva was anemic
Laboratory Finding :
Hb : 2,5 mg% MCH : 32,4
Leukocite : 900 /mm MCV : 92,3
Ht : 7 % MCHC : 35,2
Trombocite : 69.000 /mm Bood peripheral appearance:
Eritrocite :0,8 juta /mm Pansitopenia
DC :0/0/1/56/36/7
Bilirubin Total : 7,2 mg % Albumin : 3,4 g%
Globulin : 3,8 g% SGOT :22 U/I
SGPT : 23 U/I Ureum : 30 mg%
Creatinin : 0,9 mg %
Urine :
Protein - Reduction
Urobilin + Bilirubin - Lecosite : 2-3
Feses :
Color : Yellow Consistensi :mole
Working Diagnosis:
Anemia Normocitic Normocrom ec Hypoplasia ec Idiopatic
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Therapy : continued
December 5 th 2003A/: -fever (-)
A/ - fatique (+)
- appetite decreased
- Bleeding gynggiva (-)
-fever (-)
PE/:- GA LC BP PR RR T
Moderatelly ill CMC 110/60 100x/I 24x/I 37 0c
Conjungtiva : anemic
WD : same as before
Th/: continued
December 6rd 2003
A/ - fatique (+)
- appetite decreased
- Bleeding gynggiva (-)
-fever (-)
PE/:- GA LC BP PR RR T
Moderatelly ill CMC 120/70 100x/i 26x/i 360
Eye : Conjungtiva was anemic
Laboratory finding :
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Hb : 2,6 g% MCh :31,5
Leukosite : 800/mm MCV :92,3
Eritrosite : 0,82 million MCHC : 39,1
Ht : 8% Trombosite : 69.000/mm
Reticulosite : 3 % Blood peripheral appearance : normositic
normocrom,anisositosis
Wd : same as before
Th/: continued + Transfusi PRC 2 unit
December 8rd 2003
A/ - fatique (+)
- appetite normal
- bleeding gyngiva (-)
-fever (-)
PE/:- GA LC BP PR RR T
Moderatelly ill CMC 110/70 90x/i 24x/i 36,10
Eye : Conjungtiva : anemic was decreased
Hb : post transfusi december 7 rd 2003 was 5,1 %
Wd : same as before
Therapy : continued + transfusi Trombosite 10 unit
December 9rd 2003
A/ - fatique (+)
- appetite normal
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- Bleeding gynggiva (-)
-fever (-)
PE/:- GA LC BP PR RR T
Moderatelly ill CMC 120/70 82x/i 24x/i 36,0
Eye : Conjungtiva : anemic was decreased
Laboratory finding :
Hb : 6,7 g% Blood peripheral appearance : normositic normocrom
LED : 135/-
Leukosite : 900/mm
DC : 0/0/4/36/57/3
December 10rd 2003
A/ - fatique (+)
- appetite normal
- Bleeding gynggiva (-)
-fever (-)
PE/:- GA LC BP PR RR T
Moderatelly ill CMC 120/60 99x/i 25x/i 370
Eye : Conjungtiva : anemic was decreased
Wd : Anewmia normositic normocrom ec hypoplasia ec idiopatic
Therapy : same as before
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December 11d 2003
A/ - fatique (+)
- fever (-)
- appetite normal
- Bleeding gynggiva (-)
PE/:- GA LC BP PR RR T
Moderatelly ill CMC 120/7 95/i 22/i 370
Eye : Conjungtiva : anemic was decreased
Skin : not pale
Wd : Anemia normositic normocrom ec hypoplasia ec idiopatic
Therapy : same as before
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DISCUSSION
From this case, the diagnosis conclude by anamnesis, physical examination
and suggested examination. In anamnesis we fuond bleeding ginggiva since 5 days
before admitted in hospital, fatique since 9 month ago, pale since 9 month ago,
nephew of patient get bleeding diseases too (pastaway), appetite decrease since he
got ill, hardly breath since 9 months ago, dizzy since 9 months ago.
From physical exanination we found conjungtiva was anemic, bleeding
ginggiva, skin was pale.
From laboratory we found eritorsite, leucosite, trombosite
decreased( pansitopenia), Hb decreased, Peripheral blood appearance was normositic
normocrom.
Based on data from ananesis, physical examination, laboratory finding, we
built up diagnose Anemia normosytic normocrom ec hipoplastic ec idiopatic.
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Case presentation
HYPOPLASTIC ANEMIA
Presentator :
RIKA LISISWANTI
99120006
Opponent :
BOI SAIDI
96120104
Moderator :
Prof. Dr. H. NUZIRWAN ACANG, Sp.PD-KH
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DEPARTEMENT OF INTERNAL MEDICINE
MEDICAL FACULTY OF ANDALAS UNIVERSITY
PADANG
2003
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