#1
|
|||
|
|||
Íèçêèé ãåìîãëîáèí, âûñîêèé óðîâåíü òðîìáîöèòîâ
Äîáðûé äåíü. Ïîìîãèòå, ïîæàëóéñòà, ñ ðåçóëüòàòàìè àíàëèçîâ.
Ïîë æåíñêèé, âîçðàñò 45 ëåò, ðîñò 165, âåñ 52. Æàëîáû íà ñëàáîñòü. Òåðàïåâò íàïðàâèë íà óçè áðþøíîé ïîëîñòè (âñå â íîðìå) è àíàëèçû êðîâè íà îíêîëîãèþ (ïîêà íå ãîòîâû). Æäåì èõ ñ óæàñîì...êàæåòñÿ, ïîñåäåëè çà ýòè íåñêîëüêî äíåé. Çàðàíåå áîëüøîå ñïàñèáî. Âñå ïîêàçàòåëè â íîðìå, êðîìå ýòèõ: Ãåìîãëîáèí 85,37 (117-160) Ãåìàòîêðèò 32,96 (35-47) Ñðåäíèé îáúåì ýðèòðîöèòîâ, fl 63,98 (81-101) Ñð. ñîä. ãåìîãëîá. â ýð-òå, pg 16,57 (27-34) Ñð. êîíö. ãåìîãëîá. â ýð-òå, ã/ë 259,00 (310-360) Òðîìáîöèòû, 10'9/ë 496,60 (150-350) |
#2
|
|||
|
|||
Ïðèøëè äîïîëíèòåëüíûå àíàëèçû. Îíêîìàðêåðû â íîðìå. Âñå ïîêàçàòåëè â íîðìå êðîìå ýòèõ:
Ôåððèòèí 5,09 (10120) Âèòàìèí Â12 777,3 (191-663) ÎÆÑÑ 96,9 (44,80-80,60) Æåëåçî 7,5 (9,00-30,40) |
#3
|
||||
|
||||
Ó æåíùèíû - áàíàëüíàÿ æåëåçîäåôèöèòíàÿ àíåìèÿ, êîòîðóþ ñëåäóåò êîððåêòèðîâàòü ïðåïàðàòîì æåëåçà è âèò. Ñ, â ðàöèîíå - óâåëè÷èòü êîëè÷åñòâî áåëêà è ìÿñíûõ áëþä
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
|
|||
|
|||
|
#5
|
||||
|
||||
â 45 ëåò - ÷àøå âñåãî îáèëüíûå ìåñÿ÷íûå ïëþñ ïëîõîå óñâîåíèå æåëåçà èç ÆÊÒ (àòðîôè÷. ãàñòðèò?, õåëèêîáàêò. èíôåêöèÿ?).
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#6
|
|||
|
|||
|
#7
|
|||
|
|||
Âàäèì Âàëåðüåâè÷, âðà÷è ïðîäîëæàþò íàñ êîøìàðèòü. Âðà÷ ñêàçàëà, ÷òî ïðè òàêîì ãàñòðèòå íå ìîæåò òàê óïàñòü ãåìîãëîáèí. Îòïðàâèëè íà ÊÒ áðþøíîé ïîëîñòè, òàì íàøëè èçìåíåíèÿ â ïå÷åíè (êèñòà è ÷òî-òî åùå), íî âðà÷ ñêàçàë, ÷òî ê ãåìîãëîáèíó ýòî îòíîøåíèÿ íå èìååò è íà îíêî íå ïîõîæå, íî íà âñÿêèé ñëó÷àé íóæíî ê îíêîëîãó. Ðåçóëüòàòû èññëåäîâàíèÿ ïðèëàãàþ. Ïîìîãèòå, ïîæàëóéñòà.
|
|
#8
|
|||
|
|||
ïðîäîëæåíèå
|
#9
|
|||
|
|||
àíàëèçû êðîâè. åùå ñäàí êàë íà ñêðûòóþ êðîâü, êðîâü íå âûÿâëåíà.
|
#10
|
||||
|
||||
Ïîêàæèòå ñâîåìó âðà÷ó äàííóþ ðàáîòó èç Èçðàèëÿ, ãäå ïðè÷èíû ÆÄÀ èñêàëèñü ó 116 æåíùèí îò 18 äî 45 ëåò:
Clinically, significant lesions were demonstrated in 30%, the majority in the upper gastrointestinal tract. Helicobacter pylori gastritis was the most common finding (16%). Celiac disease was detected in 6%. No malignant lesions were detected. The prevalence of lesions was highest among women with symptoms of heartburn and regurgitation. The presence of upper gastrointestinal symptoms (OR: 3.67, 95%CI: 2.14-5.03; P = 0.002), MCV lower than 70 pg (OR: 1.88, 95%CI: 1.27-3.91; P = 0.04), and hemoglobin levels less than 10 g/dl (OR: 1.71, 95%CI: 1.19-4.07; P = 0.05) were associated with an increased likelihood of significant gastrointestinal lesions; history of heavy menstrual blood loss was associated with negative findings (OR: 0.46, 95%CI: 0.27-0.69; P = 0.002). Dig Dis Sci. 2008 Dec;53(12):3138-44. Prevalence and predictive signs for gastrointestinal lesions in premenopausal women with iron deficiency anemia. Carter D, Maor Y, Bar-Meir S, Avidan B. ó êàæäîé òðåòüåé - ïðîáëåìû ñ ÆÊÒ (õåëèêîáàêò. ãàñòðèò ó êàæäîé 6-îé) è ÍÈ îäíîãî ñëó÷àÿ çëîêà÷åñòâ. îáðàçîâàíèÿ. Ñðåäíèé îáúåì ýðèòðîöèòîâ ìåíåå 70 ïëþñ ãåìîãëîáèí ìåíåå 100 ïîâûøàëè ðèñê îáíàðóæåíèÿ ïðîáëåì ñ ÆÊÒ â 3 ðàçà. Âðîäå áû Ìîñêâà - îãðîìíûé ãîðîä, à Âû îáðàùàåòåñü ê êàêèì-òî ñëàáîãðàìîòíûì âðà÷àì.
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#11
|
|||
|
|||
Öèòàòà:
Ñåãîäíÿ íàì ñêàçàëè, ÷òî ó íàñ ÷òî-òî "íåîáû÷íîå è èíòåðåñíîå, íî íà îíêîëîãèþ âðîäå íå ïîõîæå". Çàêëþ÷åíèå äàëè òàêîå: ÊÒ êàðòèíà îáðàçîâàíèÿ ëåâîé äîëè ïå÷åíè (äèôôåðåíöèðîâàòü ãèïîâàñêóëÿðíîå îáðàçîâàíèå è ëîêàëüíûé ñòåàòîç ëåâîé äîëè), íåáîëüøîé êèñòû ëåâîé äîëè. ×òî ýòî ìîæåò áûòü? Èç ëå÷åíèÿ íàì âûïèñàëè Äå-Íîë, Íåêñèóì è Ñîðáèôåð. |
#12
|
||||
|
||||
Ñïðàøèâàòü íóæíî òîãî, êòî âèäåë ÊÒ âîî÷èþ è ìîæåò ïðîâåñòè äèôô. äèàãíîñòèêó, èñïîëüçóÿ äîï. ìåòîäû, à òàê ìîãó ïîâòîðèòü, ÷òî óæå íàïèñàíî: èëè ãèïîâàñêóëÿðíîå îáðàçîâàíèå, èëè ëîêàëüíûé ñòåàòîç. Íà ôîíå íàçíà÷åíèÿ íåêñèóìà ñîðáèôåð ïëîõî óñâàèâàåòñÿ - æåíùèíó ëó÷øå ïîêàçàòü Ñïåöèàëèñòó, à íå ñëó÷àéíîìó ÷åëîâåêó îò ìåäèöèíû, îäåòîìó â áåëûé õàëàò...
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#13
|
|||
|
|||
Âàäèì Âàëåðüåâè÷, äîáðûé äåíü. Çà 3 íåäåëè ëå÷åíèÿ ãåìîãëîáèí ïîäíÿëñÿ äî 109, îñòàëüíûå ïîêàçàòåëè òîæå óëó÷øèëèñü. Íî, æàëóåòñÿ íà áîëè â ñóñòàâàõ, ïîòëèâîñòü ïî íî÷àì (íåðâíè÷àåò ïî ýòîìó ïîâîäó, ïîòîìó ÷òî ñ÷èòàåò, ÷òî îíà ïîòååò ïî íî÷àì òîëüêî êîãäà áîëååò, ñîîòâåñòâåííî, îíà ÷åì-òî áîëååò, íî íå çíàåò îá ýòîì...), ãîëîâîêðóæåíèå. Ñ ÷åì ýòî ìîæåò áûòü ñâÿçàíî? Íóæíî ëè ïðîéòè äîïîëíèòåëüíîå îáñëåäîâàíèå (ùèòîâèäêà, ëåãêèå è ïå÷åíü â íîðìå)?
|
#14
|
||||
|
||||
ïðîäîëæàéòå ëå÷åíèå ïîêà ãåìîãëîáèí íå ñòàíåò áîëåå 125 ïëþñ åøå 3-4 ìåñ., åñëè ïî îêîí÷àíèè ëå÷åíèÿ êàêèå èç ñèìïòîìîâ îñòàíóòñÿ, òîãäà áóäåòå îáñëåäîâàòüñÿ
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#15
|
|||
|
|||
åùå ðàç ñïàñèáî. ïðèøëè ðåçóëüòàòû êðîâè ïî èññëåäîâàíèþ ïå÷åíè. âñå îòðèöàòåëüíîå è â íîðìå. à ïîêàçàòåëü Anti-HBc-total ïîëîæèòåëüíûé. ýòî ãîâîðèò î íàëè÷èè âèðóñà?
|