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患者刘某,男,48岁。病志号9205160。因左足疼痛,第二趾一处颜色青紫,并逐渐加重。于1992年11月27日入我院外科。确定诊断:左足脉管炎,第二趾湿性坏疽。诊治计划:(1)提出有关辅助检查。(2)暂对症、支持治疗、择期手术。1992年11月28日血常规检查:末稍血片见大量成堆成片血小板;WBC 23.0×10~9/L(<50×10~9/L)BT2min CT 5min BPCI580×10~9/L(>1000×10~9/L)。次日BPC 1500×10~9/L。进一步骨穿,其骨髓象结果;增生明显活跃;以巨核细胞增生尤著;原始与幼稚巨核细胞增多;无白血病浸润现象。据国内外诊断标准,结合临床确诊为原发性血小板增多病。据此,转入我院血液内科,针对其病因治疗,到1993年1月16日,BPC降至790×10~9/L,病情转好出院。 讨论 血小板增多症分原发(特发性)和继发性
Liu patients, male, 48 years old. Disease No. 9205160. Due to left foot pain, the second toe a color purple, and gradually increased. In November 27, 1992 into our hospital surgery. Determine the diagnosis: left leg vasculitis, second toe wet gangrene. Diagnosis and treatment plan: (1) to propose supplementary examination. (2) temporarily symptomatic, supportive treatment, elective surgery. On November 28, 1992, routine blood tests were performed: a large amount of platelets were seen at the end of a small blood sample; the WBC 23.0 × 10-9 / L (<50 × 10-9 / L) BT2min CT 5min BPCI580 × 10-9 / L (> 1000 × 10 ~ 9 / L). The next day BPC 1500 × 10 ~ 9 / L. Further bone wear, the bone marrow as a result; significantly hyperplasia; especially with megakaryocyte hyperplasia; naive and immature megakaryocytes; no leukemia infiltration. According to the diagnostic criteria at home and abroad, combined with clinical diagnosis of primary thrombocytosis. Accordingly, transferred to our hospital blood medicine, for the etiology of treatment, to January 16, 1993, BPC dropped to 790 × 10 ~ 9 / L, the condition was better discharged. Discussion Thrombocytosis sub-primary (idiopathic) and secondary