MORNING REPORT JANUARY 21TH 2014

FIRGA WATI,FEMALE, 40 YO ( FW-20)Cc : Pale since 14 days agoPresent illness history : Pain since 14 days ago, suddently, initially pale unconscious

patien’s Fever since 14 days ago , uncontinously, no sweat, no tremble, but

patient’s no fever since 3 days ago Ear of patient was buzzing since 10 days ago and no hearing loss Pain in both legs since 10 days ago, uncontinously, no refered pain

, and decreased of pain since 4 days ago Decrease of body wight was denied Apetite was usuall Nausea and vomite was denied No chest pain, no breathlesness Mixturation and Defecation were normal History of gum bleeding (-), epistaksis (-), black stool (-)

o Bluish spots on left knee since 4 days ago, no injury, no pain (-)o Swelling of the gum since 2 days agoo Patient had been hospitalized in Adnan WD Hospital since 10

days ago, patient was hospitalized for 7 days ago and get tranfusion PRC 6 bags

Past Illness History :o There is no history of illness like thiso History get of chemotherapy before was deniedFamily Illness History :o There is no families of patient have illness like thiso History of families of patient suffer cancer were denied Vital Sign :Consc : CMCBP : 130/80 mmHg HR : 88x/’ RR : 20x/’ T : 36,5 ‘C

Phsycal examination :Skin : purpura on left kneeEye : Conjuctiva not anemic,sclera not ictericMouth : Gingiva Hypertrophy, pale of tongue, stomatitis

(+)Neck : JVP 5-2cmH2OLung : I: simetris right=left ststis and dinamis

P: fremitus right=left P: sonor A: vesikuler, rales (-/-), Whezzing (-/-)

Heart : I: Ictus cordis unseen P:Ictus was palpable 1 finger medial of LMCS RIC V P: left=1 finger medial of LMCS RIC V, right:LSD Upper=RIC II A: reguller, murmur (-), M1>M2, P2<A2

Abdomen:

I : not seen bulgeP: Liver and spleen not palpableP: timpaniA: bowel sound (+) NAnus : RT: melena (-)Ext : Fisiology reflex :(+)/(+) Normal

Pathology reflex:(-)/(-) Normal Edem (-)/(-)

Laboratory:Hb : 10,6 gr/dlLeu : 13.900/mm3Ht : 31% Platelet: 4.000/mm3Diff. Count :0/1/1/35/29/0Blast : 30 %Metamielosit: 4 %Na : 138 mmol/LK : 3,7 mmol/LCl : 106 mmol/LCalcium : 8,9 mg/dlUreum : 22 mg/dlCreatinin : 0,7 mg/dl

WD/: Acute myeloblastic Leukemia

DD/ Acute Lymphoblastic LeukemiaThy : Rest/ daily diet high calori high protein IVFD NaCl 0,9% 12 hours/kolf Paracetamol 3x500mg NTR 2x1 Tranfusion tombocyte 10 unitPlanning: Liver Function testUric acidBMPImunophenotypingSitogenetic