Notes

KYIV CCH № 9 (І) Rh + (pos.)


Hematology department № 1
RW from 28.08.15
Hbs Ag отр.
EXTRACT FROM HISTORY OF DISEASE № 1489

First name: Maidanovich Maria Alexandrovna
Day of birth: 15.11.85
At the clinic at the place of residence for VTEK
Place of residence: Mykolayiv, st. Volodarsky 3, flat 31
Place of work: not working
Date of last hospitalization: 01.02.16.
Date of issue: 18.03.16.
Clinical diagnosis: Acute myelomonoblastic leukemia, M4 by FAB classification
First acute period, bone marrow remission, post-cytostatic hepatopathy. Posthepeptic conjunctivitis. Chronic anal fissure. Chronic Hemorrhoids second stage.
History of the disease: The patient was treated at the department of hematology №1
Kyiv City Clinical Hospital № 9 From 27.08.15 to date with the diagnosis mentioned above. The diagnosis was established in 2015 on August 30, 2015 on the basis of cytochemical research of bone marrow. The cytogenetic study, immunophenotyping of the bone marrow and blood parameters at the time of admission and diagnosis were not conducted.
The state of the patient at the time of arrival is difficult, caused by manifestations of the underlying disease, anemic, thrombocytopenic syndromes, Liver with palpation +1.5 cm, spleen + 1.5 cm. Peripheral lymphatic nodes are not enlarged. Complaints of severe weakness, palpitations, dizziness, body temperature up to 38,0 0C.
General blood test at primary hospitalization on 08/28/15: leukocytes-16.4 x 109 / l, red blood cells-1.21 x 1012 / l, hemoglobin - 45 g / l, platelets 15 x 109 / l, blast - 70%, stab-1, segmented-10, monocytes-0, lymphocytes-19, eosinophils-0. The patient is advised by the doctor of medical sciences, prof. Tretyak N.M.
From 02.09.15 to 08.09.15 he received a course of cytodectile polychemotherapy under the scheme 7 + 3. Cytoszar in a dose of 170 mg x 2 doses (7 days), adriablastin 100 mg / d (3 days), etoposide 130 mg / d (5 days).
Complications after the 1st course of PCT- post-cytostatic aplasia of hematopoiesis, febrile neutropenia 3st, mucositis III st, septicemia (e.aerogenes, micrococcus). Received massive antibacterial (amikacin, ceftazidime, levofloxacin, excipenem), antifungal (fluconazole, nystatin, voritab), mouth treatment. Cavity with antiseptic solutions (lysobact, amphomoronal), detoxification, hepatoprotective therapy (heptral, phosphoglucose, ursophyllum), hemostatic (etamzilate, vikasol, tranexam cytopathy), partial parenteral nutrition (Aminoplasmal - gep), KSF-grachem number 5, narcotic Analgesic - nalbuphine. The background patient receives biseptol, ciprofloxacin, and contraceptive hormones - "Yarina" throughout the course of treatment. After therapy, 7 + 3 protocol received bone marrow remission (blast-2.25%)
Myelogram of 09/28/15 is attached.
Given the fact that the patient responded to therapy and entered the remission, it was decided to conduct a reassembly program for HD A-rac.
04.10.15- put ZVK in v. Subclavia dextra without complications.
From 05.10.15 to 09.10.15 he received a course of high-dose cytosaur №1 in a dose of 3g. X 2p / d in 1,3,5 days.
Complications after the 2nd course of PCT- post-cytostatic aplasia of hematopoiesis, febrile neutropenia of the third degree, septicemia (micrococcus) - catheter sepsis. 13.10.15 - removed ZVK. Received massive antibacterial (loricacin, ceftazidime, gliutiak),Antifungal (nystatin), detoxification, hepatoprotective therapy (Geptral, phosphogels, hepa-merts), hemo-static (etamzilate, vikasol, tranexamic acid), substitution therapy, oral cavity treatment.
From 09.11.15 to 13.11.15 she received a course of high-dose cytosaur №2 in a dose of 3g. X 2p / d in 1,3,5days.
Complications after the 2nd course of PCT- post-cytostatic aplasia of hematopoiesis, febrile neutropenia of 3 degrees. Received antifungal therapy prophylactically (fluconazole, nystatin), substitution therapy, anti-inflammatory candles, KSF-grafts №2
From 15.12.15 to 19.12.15 he received a course of high-dose cytosaur №3 in a dose of 3 g. X 2p / d in 1,3,5days.
Complications after 3rd course of PCT- Post-cytostatic aplasia of hematopoiesis, febrile neutropenia of 3 degrees. Exacerbation of chronic anal fissure, acute hemorrhoids 2 degrees.
Received massive antibacterial (loricacin, tazpine), antifungal prophylactic (fluconazole, nystatin) substitution therapy, anti-inflammatory rectal candles, KSF-grafts №3
02.02.16 puncture of bone marrow (blast - 0.5%)
02.02.16 a bone marrow puncture was performed on an immunological examination (flow cytometry), the results of which are given below.
From 3.02.16 to 7.02.16 the course of high-dose cytosaur № 4 in a dose of 3g. X 2p / d in 1,3,5 days.
Complications after V course PCT- post-cytostatic aplasia of hematopoiesis, febrile neutropenia 3 st., Chronic anal fissure - aggravation, exacerbation of chronic hemorrhoids.
It received a / bacterial (amikacin, ceftazidime), antifungal prophylactic (fluconazole, nystatin), detoxification, hepatoprotective therapy (phosphogels), substitution therapy (erythrocyte mass -1 transfusion, tr. Concentrate - 2 transfusions), KSF-grafts №2, Zarcio №1. The background patient received antibiotic biseptol, ciprofloxacin, contraceptive hormones - "Yarina", anti-inflammatory rectal candles.
During the treatment for vital signs with a substitute goal, 9 was performed
Transfusion of erythrocyte mass, 9 transfusion of platelet-rich plasma О (I) Rh + (positive).
Myelogram from 28.09.15 Blastes - 2.25%, myelocytes - 18.5%, young ones - 5.75%, palmar nuclei - 15.75%, segmental cells - 10.5%, eosinophils - 0%, basophils - 0.75%, monocytes - 5.5%, lymphocytes - 3.0%, plasma cells - 0.25%, perennomocytes - 1.0%, normocytes: basophilic-12.5%, polychromatophilic - 23.25%, oxyphilic - 1.0%.
Conclusion: cellularity of the bone marrow is somewhat elevated. Erythron is expanded with a slight delay in maturation in young forms, indicating dyserotroposis. Myeloid germ is narrowed with a maturation delay on young forms. Megacariocytan germ is preserved.
Morphology and cytochemistry of bone marrow at arrival from August 30, 15.
In the bone marrow blast is given - 48%, with signs of myeloblasts and monoblast 30: 70. Myeloperoxidase is a moderate reaction in the myeloblasts, weakly positive in monoblast. Acid phosphatase reaction is diffuse from weak to moderate. КНЕ- reaction is positive in monoblast. PAS- reaction is a stable diffuse coloration of the cytoplasm. Conclusion: Acute myelomonoblast leukemia.
Myelogram before the course of PCT from 02.02.16 blast - 0.5%, myelocytes - 10%, young ones - 10.5%, palmar nuclei - 11%, segmental nuclei - 41.5%, eosinophils - 0%, basophils - 0%, monocytes - 3.0%, lymphocytes - 8.0%, plasma cells - 0%, pernorthocytes - 0%, normoglytes: basophilic-4.5%, polychromatophilic - 11%, oxyphilic - 0%.

Conclusion: Cellularity of the bone marrow is moderate. Megacariocytan germ is preserved.


General blood test Myelogram
01.02 08.02 11.02 26.02 01.03 02.02.16
Erythrocytes 1012L
2.74
3.4
2.81
2.96
2.2


















Blast
2,25
0.5
HGB gdL
103
119
104
103
95


Promyelocytes


0
PLT 109L
192
162
60
55
124


Young
5.75
10.5
leukocytes (WBC) 109L
2.5
3.4
1.4
2.5
2.85


Sticky Nuclear
15.75
11.0
Basic. ;%
1










Segment Nuclear Cells
10.5
41.5
Eoz. %
4
4
2
1




Prolymphocytes




Blast %












Lymphocytes


8.0
Прмц.%












Monocytes


3.0
Mon. %












Plasma cells


0
Young %
1










Erythroblasts




Bacill %
3
1
2
4




Pronornocytes
1,0


Segm %
50
83
36
27




Basophilic
12,5
4.5
LYM %
30
12
60
44




Polychrome


11.0
Mon. %
11
0
0
24




Oxyfil


0
ШОЕ
20
10
7
40
14


Leukocytes / Erythrocytes


5:5.1


Biochemical blood test

Parameter
Urea
Creatinine
Protein
Bilirubin
АLT
АСТ
Temporary test
glucose
Date
gen
alb
Glob
gen
пр
непр
01.02.16
3.5
86
72.1
6.06 - 0 - 6.06
0.11
0.31
0.9
4.7
08.02.16
6.2
95
80.3
12.0 - 0 - 12.0
0.38
1.0
3.2


16.02.16
3.8
88
71.6
8.08 - 0 - 8.08
0.72
0.13
0.9


26.02.16
3.5
87
74.7
5.05 – 0 – 5.05
0.11
0.16
1.1
3.2

General urine analysis

Parameter
Number
Пит.
вага
Рн
protein
glucose
acetone
leukocytes
leukocytes
leukocytes
salt
Date
08.02.16
60
m/m


0.171
-
-
0-2
-
-
-
10.03.16
80
1004








3-4






ECG from 01.02.16 ЕОС - 74 o, Heart rate 74 bpm
The patient is consulted by a surgeon (diagnosis: chronic anal fissure - exacerbation, exacerbation of chronic hemorrhoids), gynecologist, dentist (mucoside), resuscitative therapist, ophthalmologist (Dr. herpetic conjunctivitis)
02.02.16 blood is taken for HLA typing of the donor and recipient. Results in work.
Recommendations:
1. Observation of the hematologist of the IGT NAMNU ambulatory, hematologist, therapist at the place of residence.
2. Diet, diet, restriction of physical. Loads, excessive insolation, physiotherapy procedures, do not use biologically active additives !!!
3.ALLo- ТГСК in the presence of an identical donor HLA.

18.03.2016


Deputy Chief Doctor_________________ Kluchnikova O.O.

Head of department. _______________________ Melnik U.I.

Healing Doctor _______________________ Mazur М.М..