ZAPORIZHYA STATE MEDICAL UNIVERSITY CASEBOOK IN HEMATOLOGY Q & A

ZAPORIZHYA STATE MEDICAL
UNIVERSITY
CASEBOOK IN HEMATOLOGY Q & A
ZAPORIZHYA STATE MEDICAL UNIVERSITY


THE DEPARTMENT OF INTERNAL DISEASES 3




Casebook
in HEMATOLOGY


(tutorial for practical exercises for 6-year students of
medical faculty)




2015

, ZAPORIZHYA STATE MEDICAL
UNIVERSITY
CASEBOOK IN HEMATOLOGY Q & A
«RATIFIED»


by Central methodical advice of
Zaporizhzhya state medical university

Protocol № 2 from 26.11.2015




Authors:


1. Dotsenko S.Y. - Head of department of internal diseases 3, Zaporizhzhya state medical
university, associate professor, doctor of medical sciences


2. Samura B. B. - associate professor of department of internal diseases 3, Zaporizhzhya state medical
university, candidate of medical sciences


3. Sychov R.A. - associate professor of department of internal diseases 3, Zaporizhzhya state medical
university, candidate of medical sciences


4. Chornaya I. V. - associate professor of department of internal diseases 3, Zaporizhzhya state medical
university, candidate of medical sciences


5. Medvedchuck G. Y. - associate professor of department of internal diseases 3,
Zaporizhzhya state medical university, candidate of medical sciences




Практикум “Сборник клинических задач по внутренней медицине (часть V: гематология)”
(на английском языке) предназначен для самостоятельной подготовки к практическим занятиям
по дисциплине внутренние болезни англоговорящим студентам 6-го курса лечебного факультета.
В практикум включены клинические задачи, вопросы и ответы к ним, дискуссии по синдромной

, ZAPORIZHYA STATE MEDICAL
UNIVERSITY
CASEBOOK IN HEMATOLOGY Q & A
диагностике в гематологической практике.




Reviewers:


- head of the department of Clinical Pharmacology, Pharmacy and Pharmacotherapy with the Course of
Cosmetology of Zaporizhzhya state medical university, doctor of medical sciences, professor
Kraydashenko O.V.


- professor of the Family Medicine and Therapy Department of FPE of Zaporizhzhya state medical
university, doctor of medical sciences Deynega V.G.

, ZAPORIZHYA STATE MEDICAL
UNIVERSITY
CASEBOOK IN HEMATOLOGY Q & A
Contents:
Path I: Anemia ………….………….………….………….………….……………….
Path II: Leukemia and leukemoid reaction ………….………….…………………..
Path III: Polycythemia ………….………….………….………….…………………..
Path IV: Purpura ………….………….………….………….…………………………
Path V: Lymphadenopathy ………….………….………….………….…………..…
Answers and discussion to cases………….………….………….………….………….




Path I: ANEMIA

CASE 1




A healthy 52-year-old man presents to the doctor's office complaining of increasing

fatigue for the past 4 to 5 months. He exercises every day, but lately he has noticed becoming short of
breath while jogging. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), or swelling in his
ankles. The patient reports occasional joint pain, for which he uses over-the-counter ibuprofen. He
denies bowel changes, melena, or bright red blood per rectum, but he reports vague left-side abdominal
pain for a few months off and on, not related to food intake. The patient denies fever, chills, nausea, or
vomiting. He has lost a few pounds intentionally with diet and exercise.
On examination, he weighs 205 lb, and he is afebrile. There is slight pallor of the conjunctiva,
skin, and palms. No lymphadenopathy is noted. Chest is clear to auscultation bilaterally. Examination
of the cardiovascular system reveals a regular rate and rhythm, with no rub or gallop. There is a systolic
ejection murmur. His abdomen is soft, nontender, and without hepatosplenomegaly. Bowel sounds are
present. He has no extremity edema, cyanosis, or clubbing. His peripheral pulses are palpable and
symmetric. Hemoglobin level is 8.2 g/dL.
> What is the most likely diagnosis?

> What is the next diagnostic step?