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病历摘要患者女,14岁,主因发热、头痛伴呕吐五日入院。查体:T37.8℃,P120次,Bp90/60mmHg。神清,左球结膜下小片状出血,眼底正常。颈部有抵抗,双侧克氏征阳性,左侧夏道克氏征阳性。化验:血红蛋白11.4g,网织红细胞3.2％,血小板18万,白细胞19000,分叶核80％,杆状核5％,淋巴细胞14％,早幼粒细胞1％,粒细胞中可见大量的中毒颗粒。脑脊液卧位压力正常,葡萄糖1～5管阳性,白细胞24,单核细胞90％,多核细胞10％。葡萄糖、氯化物、蛋白定量正常。涂片可见幼稚细胞。骨髓象示粒:红=9.5:1,粒系统增生极度活跃,异形早幼粒细胞54％,其他各系均受抑制。诊断为急性早幼粒细胞性白血病并脑膜白血病。经用抗感染,COAP化疗方案五个疗程和鞘内注
Summary of medical records Female patient, 14 years old, mainly due to fever, headache with vomiting on the 5th admission. Physical examination: T37.8 ℃, P120 times, Bp90 / 60mmHg. God clear, left subconjunctival flake bleeding, fundus normal. Neck resistance, positive Kirschner Stroke signs on both sides of the syndrome, positive Charcot-Marie syndrome. Assay: Hemoglobin 11.4g, reticulocyte 3.2%, platelet 180,000, white blood cells 19000, leaf nucleus 80%, rod 5%, lymphocyte 14%, promyelocytic 1%, granulocytes in a large number of poisoning Granules. CSF pressure normal, glucose 1 to 5 tube positive, white blood cells 24, monocytes 90%, 10% of multi-nuclear cells. Glucose, chloride, protein normal. Pap smear naive cells. Bone marrow showed particles: red = 9.5: 1, hypergradation of granular system extremely active, promyelocytic cells 54%, other lines were inhibited. Diagnosis of acute promyelocytic leukemia and meningomatosis. With anti-infective, COAP chemotherapy regimen five courses and intrathecal injection