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患者23岁,因停经32~+周,腹痛阴道流血1d,于1986年4月21日入院。当日晨起感腹部阵痛,继之阴道流血量如月经,下午自觉阴道内脱出一物,故来就诊。末次月经1985年9月13日。1984年曾因贫血、便血,皮肤反复出现瘀斑,在本院诊断为急性红白血病,经用三尖杉酯碱,长春新硷,阿糖胞苷、强的松联合化疗,于1985年9月缓解出院。出院即结婚,停经,并未再维持化疗,也未到妇产科就诊。查体:神志清楚,贫血貌,齿龈无红肿及出血,双侧颈部可及效个黄豆大淋巴结,全身皮肤散在瘀斑,心肺正常,腹软,肝脾肋下未及,宫底脐上一指,有规律宫缩,胎心听不到。妇科检查:外阴血污,阴道少量暗红色血液。宫口开大3cm,可见黑褐色胎囊突出,宫体如孕6月大。B超提示:死胎。实验室检查:Hb 74g/L,RBC 2.25×10~(12)/L,WBC 5.6×10~9/L,N0.71;L0.26,B0.03,BPC 20×10~9/L。骨髓细胞检查:骨随增生明显活跃,粒系统占14%,红系统76%,
The patient was 23 years old and was admitted to hospital on April 21, 1986 because of 32 to + weeks of menopause and 1 year of abdominal pain and vaginal bleeding. On the morning of a sense of abdominal pain, followed by vaginal bleeding such as menstruation, spontaneous vaginal prolapse in the afternoon a thing, it came to the clinic. The last menstruation September 13, 1985. In 1984, anemia, hematochezia, skin recurrence of ecchymosis, in our hospital diagnosed as acute erythroleukemia, with harringtonine, vincristine, prednisone combined with chemotherapy, in 1985 9 Month ease discharge. Discharged from marriage, menopause, did not maintain chemotherapy, but also to obstetrics and gynecology treatment. Physical examination: conscious, anemic appearance, no swelling and bleeding gums, both sides of the neck can be used to effect a large lymph nodes, systemic skin scattered ecchymosis, normal heart and lung, abdominal soft, liver and spleen ribs under, A means, regular contraction, fetal heart can not hear. Gynecological examination: vulva blood, vaginal a small amount of dark red blood. Miyaguchi open large 3cm, visible dark brown fetal sac prominent, such as pregnancy in June large palace. B-Tip: stillbirth. Laboratory tests: Hb 74g / L, RBC 2.25 × 10-12 / L, WBC 5.6 × 10-9 / L, N0.71; L0.26, B0.03, BPC 20 × 10-9 / L. Bone marrow cell examination: Bone significantly active with proliferation, accounting for 14% of the granular system, 76% of the red system,