Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

Patient K., 60 years old, was hospitalized in the Central District Hospital at the place of residence in connection with

severe weakness, shortness of breath, palpitations at the slightest exertion.

I felt weak for several years, the last 2 years I began to notice pain in the spine.

In her youth she was a blood donor 8 times, has 3 children, had 4 abortions. General practitioner

Sorbifer was assigned as a precinct in connection with the detected anemia (red blood cells - 3.12 × 1012 / l)

Durules 2 tablets per day for 1.5 months. No effect was obtained. General analysis

blood: red blood cells - 1.42 × 1012 / l; hemoglobin - 50 g / l, color indicator - 1.0;

reticulocytes - 0.4%; platelets - 98 × 109

/ l; white blood cells - 2.6 × 109

/ l (stab

neutrophils - 3%, segmented neutrophils - 30%, lymphocytes - 60%, monocytes -

7%), anisocytosis ++++, poikilocytosis +++; ESR - 72 mm / hour.

The questions are:

1. Is it possible to preliminarily make one of the following diagnoses:

"Aplastic anemia"? "Acute leukemia"? "Multiple myeloma"?

2. How to make a preliminary diagnosis?

3. Does the patient need a hematologist's consultation, sternal puncture?

4. In biochemical analyzes revealed: total blood protein - 140 g / l, albumin -

30%, globulins - 70%, an M-gradient was detected in the gamma-globulin zone. Will it shrink

Your diagnostic search?

5. In which department should this patient be treated?