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ID: Mr N / 52 yo / farmer

Chief complain : body felt weak

Recent historysince one week ago the patient feel the body feels weak, is felt throughoutthe body, continuous, increases with activity and decreases with rest,fatigue is not relieved by feeding, accompanied by blurry vision, especially

when posos change from sitting to standing or move, swallow pain no, noears, no bleeding, no bleeding gums, bruising on the skin also does not

exist, the patient also complained about perceived breathlessness since 1week ago, shortness continuously increases with activity, decreasedslightly with rest, shortness not affected by changes in emotions, weatheror dust, regular patient more comfortable 2-3 cushion, and sometimes thenight awakening due to crowded, swelling in the feet is not felt, no body

heat, cough and colds as well not exist. no nausea and vomiting. urinate 6-8 times / day @ 1/2-1 cup starfruit, canary yellow, pain during urination (-).1-2 bowel movements once a day, soft consistency, mucus blood (-), outbumps during bowel movements are not perceived

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2 month before hospitalized,with fatigue and pale, the

patient had blood transfusion red is 7 colf and The

patient out from hospital before doctor do BMP.

Previous history : DM (-)

HT (-),

hepatitits(-)Hearth disease (-)

Habitual History : housewife, smoker(-),

drink free drugs(-), herbal(-)

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Physical Examination7

Moderate sick, normoweight nutrition, compos mentis

Common Conditions:

Vital Sign :

BP : 110/70 mmHgpulse : 100x/mnt, reguler

RR : 24 x/menit

T : 37,2 oC (aksiler)

WB : 50 kgTall : 158 cm

BMI : 20,7 kg/m2

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JVP R+2cm,Limfonodi coli (-)

Eye : pale conjungtiva (+/+), sclera icteric (-)

Oedem (-/-), nail flat(-)

THX:, normochest, chest retraction (-),spider naevi(-), atrofi M pectoralismayor(-),

Cor:I. IC no appearP. IC palpate SIC V 2 cm lateral LMCS,

heavyP. Configuration is widen caudolateralA. HS I-II reguler, mumur pansistolic (+) grd

2/6 all chamber, referred (-), gallop (-)

AbdomenI. AW same as heigh CW,

A. Peristaltic sound (+) normallyPe. Thympani, traube area thympani

Liver span 8 cm,Pa. Soefel, tenderness(-)

H/L not palpable

Front side pulmo:

I. Movement of the chest simetric

P. Tactile Fremitus left=right norma

P. sonor/sonor normal

A. Basic sound : vesiculer normsl

complem entary : (-)

Back side pulmo:

I. Movement of the chest simetric

P. Tactile Fremitus left=right norma

P. sonor/sonor normal

A. Basic sound : vesiculer normsl

complem entary : (-)

Pale(+), cianotic(-), papil toungeatrophy(-), hipertrophy ginggiva(-),

bleeding gums (-),

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Laboratorium14

Nilai Satuan

Haemoglobin 2,0 g/dl

Eritrosit 0,51 106/ul

Hematokrit %

Lekosit 2,9 103/ul

Trombosit 15103/ul

Random blood glucose 118 mg/dl

Ureum 18 mg/dl

Kreatinin 0,7 mg/dl

SGOT 18 u/l

SGPT 18 u/l

Na 136 mmol/l

K 3,8 mmol/l

Cl 105 mmol/l

HBsAg nonreaktif

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Rontgen16

Foto thorax PA position, hard enough, inspiration not

enaugh, can still distinguish soft and hard tissue, the

trachea in the middle, left parenkim didnt infiltrat, the

angle of taper costophrenicus right and left, between the

ribs is not widened, elevated diaphragm (-)

Cor: CTR >50%,

Conclusion: cardiomegaly with pulmo normal

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Conclusion:

Sinus tahikardia with HR 106 bpm

ECG

Sinus tachycardia

QRS rate : 106 bpm

Axis : Normoaxis

P Wave : 0,04 s (normal)

PR interval : 0,16 s (normal)

QRS duration : 0,08 s(normal)

ST segment : isoelectric

Inversion T wave : -

LVH/RVH : -

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Eritrosit : Normokrom, normosit, anisositosis,, seleritroblast(-)

Leukosit : normal number, sel blast(-)

Trombosit : decrease, Conclusion : anemia hipokrom mikrositik, with

trombositopenia

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Problem I18

Pansitopenia

Ass :

dd anemia aplastikMDS

IpDx : Reticulosit, PT, APTT, Feces routine, BMP

IpTx : Partial Bedrest sheet potitionO2 canul 2 lpm

Diet rice TKTP

IVFD NaCl 0,9%20 tpm

Blood transfusion PRC 1500cc ( 500 cc/ a day )

IpMx : DR3 post transfusion, bleeding

IpEx : education patient and his family about his disease and

complication

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Problem II18

CHF NYHA IV

LVH

AHD

Ass :

IpDx : echocardiographi

IpTx : Partial Bedrest sheet potitionO2 canul 2 lpm

IpMx : vital sign

IpEx : education patient about his disease.

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06.00

S : fatigue (+)

O : compos mentis, moderate sickness

TV : T :110/70 RR : 20 x/menit N : 96 x/menit t : 36,5

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THANK YOU

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Klasifikasi Anemia Berdasarkan Morfologi dan EtiologiAnemia mikrositik hipokromik:

1. anemia defisiensi besi2. thalasemia mayor3. anemia sideroblastik4. anemia akibat penyakit kronis

Anemia normositik normokromik:1. anemia pasca perdarahan akut2. anemia aplastik

3. anemia hemolitik didapat4. anemia akibat penyakit kronik5. anemia pada gagal ginjal kronik6. anemia pada sindrom mielodisplastik7. anemia pada keganasan hematologik

Anemia makrositik:

1. anemia defisiensi asam folat2. anemia defisiensi B123. anemia pada penyakit hati kronik4. anemia pada hipotiroidisme5. anemia sindrom mielodisplastik

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Kriteria AnemiaWHO menetapkan cut off point anemia antuk keperluan penelitianlapangan seperti terlihat pada tabel 1.Tabel 1. Kriteria Anemi Menurut WHOKelompok Kriteria Anemia (Hb)Laki-laki dewasa < 13g/dlWanita dewasa tidak hamil < 12g/dlWanita hamil < 11g/dl