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患者,女,44岁,不规则低热半年,左上腹肿块进行性增大3月余。拟诊:脾肿大原因待查,慢性粒细胞白血病急性变。病中有关节痛,用止痛药可缓解,无出血倾向。既往身体健康。体检:T37℃,消瘦,中度贫血貌,心尖区可闻及Ⅱ级收缩期吹风样杂音;肝肋下2cm,脾肋下14cm,质中、无压痛;无腹水征;双下肢轻度凹陷性水肿。实验室检查:Hb 60g/L;WBC 20×10~9/L,幼稚细胞66％;BPC 300～400×10~9/L;免疫球蛋白;IgG2190mg％,IgA161mg％,IgM168mg％,C_3 205,ANA(-),LDH1070u/d1,AKP 87u/金氏。胸部X线可见两下肺呈炎性病变,肝、脾B型超声波2次提示肝硬化、门脉高压、余项正常。骨髓涂片3次增生活跃,其
Patients, female, 44 years old, irregular low fever six months, the left upper abdominal mass progressive increase more than 3 months. To be diagnosed: splenomegaly reasons to be investigated, acute myeloid leukemia. Joint pain in the disease, with painkillers can ease, no bleeding tendency. In the past, good health. Physical examination: T37 ℃, weight loss, moderate anemia, apex area can be heard and grade Ⅱ systolic hair-like murmur; liver ribs 2cm, spleen ribs 14cm, quality, no tenderness; no signs of ascites; Edema. Laboratory tests: Hb 60g / L; WBC 20 × 10-9 / L, immature cells 66%; BPC 300-400 × 10-9 / L; immunoglobulin; IgG2190mg%, IgA161mg%, IgM168mg%, C_3 205, ANA (-), LDH1070u / d1, AKP 87u / gold. Chest X-ray showed two lungs were inflammatory lesions, liver and spleen B-mode ultrasound prompted cirrhosis, portal hypertension, the remaining normal. Bone marrow smear 3 hyperplasia active, its