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病历摘要李××,女,32岁.以头晕、乏力3年余,伴周身淋巴结肿大10天,于1991年8月10日入院.该患曾于3年前,无明显诱因,出现头晕、乏力,间断鼻衄,就诊我院,末梢血象除血小板50×10~9,余均在正常范围。查体:非贫血貌,齿龈增生(+),胸骨压痛(±),脾大肋下3.0cm。经骨穿诊为:“骨髓增生异常综合征—RAEB期。”给予氨肽素、益血升及激素类治疗,血小板无上升趋势。于1989年在我院行脾切除,术后约1周血小板升至正常范围200×10~9左右,半个月后下降至60×10~9左右,并一直波动在此范围。未进行特殊治疗。此次入院前10天开始自觉头晕、乏力加重,周身淋巴结肿大,月经量过多,经自求恩医大一院骨穿确诊为“骨髓增
Medical record summary Li × ×, female, aged 32. To dizziness, fatigue for more than 3 years, with peripheral lymphadenopathy for 10 days, admitted to hospital on August 10, 1991. The patient had no obvious incentive 3 years ago, dizziness , Weakness, intermittent epistaxis, treatment in our hospital, peripheral blood platelets in addition to 50 × 10 ~ 9, the remaining in the normal range. Physical examination: non-anemic appearance, gingival hyperplasia (+), sternal tenderness (±), splenic ribs 3.0cm. The diagnosis of bone as: “myelodysplastic syndrome-RAEB period.” Given aminopeptidase, benefit blood and hormone therapy, platelets no upward trend. In 1989, we performed splenectomy in our hospital. After about 1 week after operation, the platelets rose to the normal range of 200 × 10 ~ 9, and dropped to 60 × 10 ~ 9 after half a month, which has been fluctuating in this range. No special treatment. 10 days before the admission began to feel dizzy, fatigue worsened, the whole body lymph nodes, excessive menstrual flow, since the Bethune Medical College bone bone diagnosed as "bone marrow increased