Anemia e.

c Suspect Multiple Myeloma

By: Elfira

Anamnesis Autoanamnese pada 6 7 Agustus 2012 jam 10.00 Alloanamnesis dengan Tn A (suami) 7 Agustus 2012 jam 12.00

IDENTITY
Name Age

Sex
Address Education Occupation Religion Marital status

Ny. Y 31 years old Female

Dusun I Krajan 01/01 Pasir Tanjung, Karawang

Elementary school Housewife Islam Married July 30 th 2012 Rengasdengklok

Admitted
Taken from

INTERVIEW
MAIN COMPLAIN

Difficulty of breathing since 2 days before hospitalized

ADD COMPLAIN

Nausea, Vomit, No defecation since 7 days before hopitalized, Hard to moving, Dizziness, and Backache,and Weak

History Of Present Illness

A patient came to Emergency Unit RSUD Karawang with a complaint of difficulty of breathing since 2 days ago. The symptom first always appeared in the night but now its appeared whole of the days. Patient feels airless and also dizziness especially in her backhead. She also complaint always got cough without split, and got nausea and vomite everyday since 1 week before hospitalized. No defecation until 1 week and feel so weak.

She also complained of having pain in her back and also cant moving for 3 months before hospitalized. She confessed that before it happen, one day when she just woke up, she move her chest usual after sleep and suddenly she remembered there was a huge sound like something broken and also without pain. At first it looked normal, but after 3 months, she cant move her upper body until now (7 August) and it getting worse

Picture of Patient

History of Past Illness

Tuberculosis (-) Kidney Disease (-)
Hypertension (-)
Diabetic Mellitus (-)

Same illness (-)

Bone Disease (-)

Asthma (-)

Trauma (-)

History of Family
No Family got same illness Hyper Tension Asthma -

Tuber Culosis

Diabetic Melitus -

Medication History
The patient has never been admitted to hospital before Consume certain drugs and taking jamu pegal linu just to get rid of the backache

Personal and Habitual History

Daily meal consumption (+) - Coffee 1 cups/day - Sweet things : not so much

Alcohol consumption (-) Smoking (-) Routine Excercise (-) Rare Tattoos (-) Blood Transfusion (-)

Injected drugs (-) Traditional drinks(+) 3 cups / day especially when her backache attack

General Condition
General Appearance
Moderately ill

Conciousness
Compos Mentis

Height / Weight
165 / 60

BMI
22, 2 Normal

Vital Sign
Blood Pressure 110/70
Temperature 36. 5 C Heart Rate 80 x / minute Respiration 24 x / minute

Physical Examination
Head
Normocephaly

Eyes
ANEMIC CONJUCTIVA +/+ ICTERIC SCLERA -/-

Neck
Lymph Node is not palpable big Thyroid gland is not palpable big

Mouth, Pharinx, and Nose

Lip : Cyanosis (-), Pallor (-), Stomatitis (-) Pharinx: Hiperemis (-), No secret (-) Nose: Napas Cuping Hidung (-), Cyanosis (-)

Thorax
INSPECTION
Ictus Cordis is Not Visible

PALPATION
Ictus Cordis is palpable at 5th ICS Midclav Sinistra

PERCUSSION
Right heart border: ICS 3-5 Sternalis Dextra Left heart border: ICS 5 1cm medial Midclav Sinistra Upper heart border: ICS 3 Sternalis Sinistra

AUSCULTATION

- Regular I II Heart Sound, Murmur (-), Gallop (-)

Thorax
Inspection : Asymetrical Supraclavicula retraction(-) Intercostalis retraction(+) :Equal vocal fremitus, krepitation

Palpation (+/+) Percussion :Sonor in both lung, iga and costa feel not intact (+) Auscultation :Vesicular breath sound in both lung Wh -/-, Rh +/+, Friction (+)

Abdominal Examination
Inspection Brown skin, No peristaltic move seen Palpation No Pain on palpation at Epigastric, Hipogastric, and Suprapubic Liver not palpable Spleen not palpable Percussion No pain present on abdominal percussion = Tymphani Sound Dullness (-) Shifting dullness (-) CVA (+) Auscultation Bowel sound (+) 2 times/minute. Arterial bruit (-), venous hump (-)

Extremity Examination
WARM ACRALS
+ + +

OEDEM
-

Laboratory Finding
Blood
Hb Ht

Results
6.0 18%

Normal
12-14 g/dl 37-43 %

Trombosit
Leukosit ESR Limphocytes GDS Ureum Creatinin

250.000
13.000 10 20 101 116.5 2.61

150.000-450.000
5000-10.000 % 20-40 % 80 140 mg/dl 10-45 mg/dL 0,4-1,5 mg/dL

02nd August 2012

Blood
Hb Total Protein Albumin

Results
9.8 (post trans 3 kolf) 7,16 4,60

Normal
12-14 g/dl 6-8 g/dl 3,6 5 g/dl

Globulin

2,56

2.3 3.5 g/dl

Blood
Calcium

Results
11.2

Normal
3-10 g/dl

Thorax Rngten

Rngten Schedell Ap / Lat

Resume
Physical Examination
Difficulty of breathing. Headache. Weak. Cant moving Pain on back. Nausea and Vomite Cough No defecation

History Taking

Anemic conjungtiva +/+ Krepitation (+/+) I and II ribs Rh +/+ friction +/+

Adjuvant Test

Hb : 6,0 g %. Post: 9,8 Ht : 18 % Leukocyt : 13.000 Protein total : 7,16. Albumin : 4, 60 mg %. Globulin : 2,56 mg % GDS : 101 Ureum: 116,5 mg% Creatinin :2,61 mg% Calcium: 11,2 2

Working Diagnosis

Anemia e.c Multiple Myeloma

Differential Diagnosis
Malignant Lymphoma Acute Leukemia Metastatic Lung Carcinoma Waldenstrom Hypergammaglobulinemia Osteomalasia

Suggested Examination
Bone Marrow Puncture Tissue Biopsy Plasmacytoma Serum Protein Electrophoresis

Treatment (06 August 2012)

PHARMACOLOGY NONPHARMACOLOGY HCHP Diet
- IVFD Titofusin : D5% 1 : 1 20 dpm - Ceftriaxone 2 x 1 gr - Azitromicin 1 x 500 mg - Pamol 2 x 1 - Intervask 1 x 10 mg

Furosemid 2 x 1 Inj KSR 1 x 1 Valsartan 1 x 10 mg Dulcolac 2

Prognosis
Ad Vitam
Dubia ad Malam

Ad Functi onam
Dubia ad Malam

Ad Sanati onam
Dubia ad Malam

THANK YOU