ANSWERS ON QUESTIONS

Main part

A 28-year-old woman consulted a local GP with complaints of

weakness, fatigue, palpitations, dizziness, headache, worsening

memory, leg pain, desire to eat dry pasta, buckwheat, sore throat.

From the anamnesis it is known that anemia was discovered from 16 years old. Treated irregularly

iron preparations in courses of 2-3 weeks with a temporary effect.

Gynecological history: menstruation from 14 years old, profuse, 5-7 days after 21

day. 2 pregnancies, 2 urgent physiological births at 23 and 27 years.

On examination: the patient's condition is satisfactory. Height - 162 cm, body weight -

65 kg BMI - 24.08 kg / m 2 . The skin and conjunctiva are pale. Thin nails

sealed, the ends of the nails are stratified. In the lungs, vesicular breathing, no wheezing. NPV -

18 per minute. Heart sounds are weakened, the rhythm is correct, it is heard during auscultation

systolic murmur at the apex of the heart and along the left edge of the sternum, heart rate - 110 beats per

minute, blood pressure - 110/70 mm RT. Art. The abdomen is soft, painless on palpation in all

departments. The liver and spleen are not enlarged. Symptom of lumbar effusion

areas are negative. Physiological administration is normal.

In the analyzes: general blood test - red blood cells - 3.6 × 10 12 / l, anisocytosis,

microcytosis, Нb - 94 g / l, CP - 0.6, white blood cells - 5.2 × 10 9 / l, eosinophils - 1%,

stab - 3%, segmented - 57%, lymphocytes - 28%, monocytes - 9%, ESR -

25 mm / hour.

Biochemical blood test: total protein - 77 g / l, total bilirubin - 15.3

μmol / L, indirect bilirubin - 12.1 μmol / L, serum iron - 7.6 μmol / L,

ferritin - 8.8 mcg / l.

ECG: sinus tachycardia, heart rate - 106 per minute, a decrease in the T wave in the left

thoracic V5, V6 leads.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. Which drug from the group of iron-containing drugs would you

recommended to the patient? Justify your choice.

5. After 2 months of regular therapy, there is a positive trend:

weakness and fatigue decreased, memory improved, palpitations did not

disturbed; taste impairment disappeared; in a general blood test - red blood cells -

4.2 × 10 12 / l, the average diameter of red blood cells is 7.5 μm, Нb is 122 g / l, the CPU is 0.84,

leukocytes - 6.7 × 10 9 / l, eosinophils - 0%, stab - 2%, segmented -

59%, lymphocytes - 28%, monocytes - 9%, ESR - 13 mm / hour. Biochemical analysis

blood: serum iron - 14.7 μmol / l, ferritin - 9.8 μg / l. What is your

further treatment tactics? Justify your choice.

Situational task 131 [K001946]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient M., 52 years old, came to the clinic with complaints of unmotivated

weakness, increased fatigue, a constant feeling of heaviness in the left hypochondrium,

decreased appetite, a feeling of quick satiety. These complaints appeared around 5

months ago and gradually became more pronounced.

On examination, an enlarged spleen (stands out from under

edges of the costal arch by 6 cm).

Blood test: hemoglobin - 105 g / l, color indicator - 0.94, white blood cells -

68.3 × 10 9 / l (promyelocytes - 1%, neutrophilic myelocytes - 2%, neutrophilic

metamyelocytes - 6%, neutrophilic stab nuclear - 14%, neutrophilic

segmented - 58%, lymphocytes - 9%, eosinophils - 2%, basophils - 7%, monocytes -

1%), platelets - 440 × 10 9 / L. The activity of alkaline phosphatase neutrophils is reduced.

Questions:

1. Assume and justify the most likely diagnosis.

2. Make a plan for an additional examination of the patient to confirm

the diagnosis.

3. What indicators of the blood test of this patient do not correspond to chronic

stage of the disease? Justify the answer.

4. Cytogenetic analysis revealed the presence of a Ph chromosome, in accordance with

by clinical signs, the patient was stratified into the category

intermediate risk. Indicate the initial treatment tactics for this patient.

5. What are the signs of complete hematological remission in the treatment of this

diseases. Justify the answer.

Situational task 132 [K001947]