CHRONIC LIMFOBLASTIK

LEUKEMIA

Ulfa Hasani Al-adibah030.08.246

IDENTITY • Mr .TName• 42 years oldAge • MaleSex • Cilamaya Kulon RT/RW 09/04 KarawangAddress • elementary schoolEducation • Labour Occupation • MoeslemReligion • MarriedMarital status• September 23th 2012Admitted • SundaneseEthnic

AnamneseAutoanamnese, taken on Wednesday 27

september , 2012

• Vomiting of blood since 1 month before hospitalizedMain

Complaint• Dizziness• fatigue• Fever• nausea• Shortness of breath• Gum bleeding• Coughing up blood

Additional Complaint

Patient came to Emergency Unit of Karawang City Hospital with complaint of vomiting of blood since 1 mounth before hospitalized.

He also felt dizziness , intermittent fever for 1 month and felt fatigue,nausea, shortness of breathing, gum bleeding since 2 month before hospitalized.

Patients complain vomiting of blood while in hospital and he also complained of bleeding gums. The blood that came out a dark red,and the volume is not too much.

Patient also say that his legs felt pain.

History of Present Disease

HISTORY OF PAST ILLNESS

SAME ILLNESS BEFORE (-)

HYPERTENSION( - )

DIABETES( - )

KIDNEY DISEASE( - )

ASTHMA( - )

ALLERGY

( - )

FAMILY HISTORY

SAME DISEASE( - )

HYPERTENSION( - ) DIABETES

( - )

KIDNEY DISEASE

( - )

ASTHMA( - )

HEART DISEASE (-)

Alcohol consumption (-)

Smoking (+)

Routine Excercise (-)

Tattoos (-)

Blood Transfusion (-)

Injected drugs (-)

Traditional beverages (-)

Habits History

• Moderately ill

General appearance

• Compos mentis

Consciousness

General Condition

VITAL SIGNS Blood Pressur

e• 100/6

0mmHg Heart

Rate• 90x/mins

Respiration Rate• 20x/mins

Temperature• 35,8 ͦ

C

Physical Examination

• Normocephali Head• Anemic conjunctiva +/+• Icteric sclera -/-Eyes• Lip: cyanosis(-)• Pharynx: hyperemic (-),

symmetrical, uvula at midlineMouth• Lymph gland & Thyroid gland is not

palpableNeck

Thorax Examination

I : Symmetrical Pal : Equal vocal resonancePer : Sonor in both lungsA : Vesicular breath sound in both lung,ronchi (-/-),wheezing (-/-)

INSPECTION

Ictus cordis is invisible

PALPATION• Ictus cordis is palpable at 5th ICS LMCS

PERCUTION• Right heart border: ICS III-V LSD• Left heart border: ICS V 1cm medial LMCS• Upper heart border: ICS III LPSS

AUSCULTATION• Regular I - II absence of murmurs and gallop in

heart’s sound

Heart Examination

ABDOMINAL EXAMINATION

Inspection : Brown skin, Flat Palpation : Sociable (-),tenderness (+) splenomegali (+): palpable at

S4

Percussion : pain present on abdominal percussion Sounds dull

Auscultation :Bowel sound (+), arterial bruit (-), venous hum(-)

Extremity Examination

Warm acrals

Oedema

Purpura

+ ++ +

- -- -

- -- -

LABORATORY FINDINGseptember , 23 2012

Blood Results Normal

Hb 2,4 12-14 g/dl

Ht 8 37-43 %

Trombocyte 114.000 150.000-450.000

Leucocyte 120.000 5000-10.000

MCV 111 82-92

MCH 30 27-31

MCHC 27 32-35

RDW 28 11,6 – 14 %

Peripheral Blood SmearSeptember 23th 2012

USG Abdomen

Interpretation

RESUMEAnamnese

• Fatigue• Dizziness• Fever • Nausea • Vomiting of blood

• Gum bleeding

• Shortness of breath

• Bone pain

Physical Examinatio

n• Anemic conjungtiva +/+

• splenomegali

Adjuvant Test

• Blood Test• Hb : 2,4 g%• Ht: 8 %• Leukocyte :

120.000• Trombocyte:

114.000• Peripheral

Blood Smear: suspect cronic limfloblastik leukimia

Chronic limfoblastic leukemia Prolimfositik Leukimia Hairy cell Leukimia Chronic cell T Leukimia Mantle cell lymphoma Limfoplasmasitic leukemia

Differential Diagnosis

Working Diagnosis

Cronic Limfloblastik Leukemia

Bone marrow aspiration

Suggested Examination

Cytochemical staining

Treatment

IVFD NaCl 0,9% 20 tpm

PRC Transfusion 5

unit

Kalnex 3x 500 mg IV

Ceftriaxone 2x 1gr IV

Omeprazole 1x1

Chemotherapy

PROGNOSIS

Ad sanationam :

Dubia ad malam

Ad Fungsionam :

Dubia ad

malam

Ad Vitam :

Dubia ad malam