临床诊断学血液系统疾病体检.pptx

Physical examination of patients with blood disorder血液系统疾病体检血液科 苏力RBC(Hb) decrease: anemia increase: polycythemia 红细胞增多症WBC decrease: infection increase: infiltrationplatelet decrease: bleeding increase: thrombosisRBC(Hb) decrease: anemiasymptoms: fatigue, tinnitus耳鸣 palpitation on exertionsigns: skin and mucosa pallor, tachycardiaHaemolytic anemia: signs : jaundice, and pallor睑结膜苍白常见于缺铁性贫血镜面舌 无舌苔 常见于巨幼细胞性贫血RBC(Hb) increase: polycythemia expanded blood volume and increase blood viscosity黏度symptoms: headache, dizziness, tinnitus, blurred vision视力模糊sings: ruddy skin, rubor皮肤红, spleen enlargement Thrombocytopenia: bleeding出血点petechia：≤2mm紫癜 purpura：3-5mm瘀斑 ecchymosis：＞5mm血肿hematoma：鼻衄epistaxis：牙龈出血gingival bleeding：眼底出血、脑出血、血尿、血便、黑便、月经过多PetechiaePurpuraHereditary haemorrrhagic telangiectasiahemarthrosishemophiliahematomaAllergic PurpurasHereditary haemorrrhagic telangiectasiaSenile purpureThrombocythemia: thrombosisLeukopenia: infectionSymptoms and signs: fever ……Leukocytosis: infiltrationSymptoms and signs: enlargement of liver and spleen enlargement of lymphonodeSternum tenderness胸骨压痛Symptom and signs in patients with blood disorders :skin and mucosa ：pale、jaundicepetechia、purpura、ecchymosisenlargement of lymph nodeenlargement of spleen or/and livertachycardia 诊断学病例：女,17岁，头晕,乏力半年,平素月经多,偏食。查体:皮肤苍白, 无黄染，心尖部可闻及Ⅱ级收缩期杂音,肝脾未触及，血常规：Hb75g/L, MCV64fL, MCH21pg, WBC4.5×109/L, PLT120×109/L,按贫血形态学分类属哪类贫血?A.大细胞性贫血B.小细胞低色素性贫血C.小细胞性贫血D.正细胞性贫血E. 溶血性贫血B女性,55岁,头昏,乏力伴皮肤黄染一个月,体检:巩膜轻度黄染,脾肋下2cm,化验:血红蛋白65g/L,网织红细胞0.12,初步诊断是A.肝炎B.胆囊结石C.缺铁性贫血D.溶血性贫血E.地中海性贫血D男性 31岁,因乏力，发热,齿龈与鼻腔出血,黑便一周入院,体查：皮肤粘膜苍白，未见黄染，弥漫瘀点和大片瘀斑, 胸骨有压痛，牙龈肿胀，颈部和腋窝可触及多个浅淋巴结，相互融合，脾脏左肋下2厘米，实验室检查：Hb70g/L,WBC1.0×109/L,幼稚细胞50%,血小板24×109/L,骨髓增生明显活跃, 异型幼稚细胞80%, 并可见成堆棒状小体,过氧化酶染色阳性，基因检查发现AML1-ETO阳性 。患者的诊断是:A.急性单核细胞白血病B.急性红白血病C.急性早幼粒细胞白血病D.急性淋巴细胞白血病E.急性粒细胞白血病M2E