摘要
目的报告1例被误诊为失血性贫血的多发性骨髓瘤(MM)患者的诊治过程,分析误诊原因和临床特点。方法甘肃省环县人民医院收治1例以失血性贫血为主要症状的患者,经血常规、凝血功能、影像学、骨髓形态学等检查考虑MM,转至上级医院后检查确诊。结果患者为62岁男性,因"黑便、乏力、纳差20 d"于2017年8月10日首次入院,血常规检查红细胞计数(RBC)为1.7×10^(12)/L,诊断为上消化道出血、失血性贫血、食管溃疡、慢性胃炎,经输血、止血等治疗后贫血无改善,于8月18日出院。患者于10月9日再次入院,骨髓形态学检查显示浆细胞异常增生,骨髓病检显示骨髓增生不均一,骨小梁破坏,考虑MM。患者于10月16日转至兰州大学第二医院,经检查诊断为MM,经化疗辅以其他对症支持治疗后,患者骨痛、贫血等症状好转,于11月10日出院。结论MM初期患者表现常不典型,易被误诊,应及时进行骨髓细胞形态学观察和骨髓活检等,减少误诊的可能。
Objective To report a case of multiple myeloma(MM)misdiagnosed as hemorrhagic anemia,and to discuss the causes of misdiagnosis and clinical features.Methods A patient with hemorrhagic anemia as the main symptom was admitted to People’s Hospital of Huan County.MM was considered according to routine blood test,coagulation function,imaging,bone marrow morphology and other examinations.The patient was transferred to a higher level hospital for examination and diagnosis.Results A male patient aged 62 years old was admitted to hospital for the first time on August 10,2017 due to"black stool,fatigue,anorexia for 20 days".The routine blood test showed that red blood cell count(RBC)was 1.7×10^(12)/L.He was diagnosed as upper gastrointestinal bleeding,hemorrhagic anemia,esophageal ulcer and chronic gastritis.After blood transfusion,hemostasis and other treatment,the anemia did not improve and the patient was discharged on August 18.The patient was hospitalized again on October 9.The bone marrow morphology examination showed abnormal proliferation of plasma cells,and the bone marrow pathological examination showed heterogeneous bone marrow proliferation and trabecular bone destruction,MM was considered.The patient was transferred to the Second Hospital of Lanzhou University on October 16 and was diagnosed as MM.After chemotherapy and other symptomatic support treatment,the symptoms of bone pain and anemia improved and he was discharged onNovember 10.Conclusion In the early stage of MM,the symptoms are often atypical and easy to be misdiagnosed,bone marrow cell morphology and bone marrow biopsy should be performed in time to reduce the possibility of misdiagnosis.
作者
蔺金军
魏军龙
赵鸿薇
Lin Jinjun;Wei Junlong;Zhao Hongwei(Clinical Laboratory,People's Hospital of Huan Country,Qingyang 745700,Gansu,China)
出处
《实用检验医师杂志》
2021年第1期59-61,共3页
Chinese Journal of Clinical Pathologist
关键词
多发性骨髓瘤
误诊原因
临床特点
Multiple myeloma
Cause of misdiagnosis
Clinical feature
