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郭某,女,50岁,因心悸、怕热、腹泻、逐日消瘦三月,在某医学院诊断为甲状腺机能亢进症,服他巴唑二月后同时因伴头晕、鼻腔及牙龈出血而于1987年5月18日住我院。查体:T37.7℃,P94次/分,BP124/70mmHg,体重38kg。贫血貌,巩膜黄染。甲状腺Ⅱ肿大,闻及血管杂音。心律齐。肝未触及,肝肋下2cm。手颤(+)。化验:血红蛋白61g/L,白细胞4.6×10/L,网织红细胞10％,血小板21×10g/L,总胆红素41nmol/L,SGPT正常。HBsAg(-),尿胆红质(-),尿胆原阳性1:20(-),T_38.74nmol/L,T_4182nmol/L,Ham试验(-),Coombs试验直接(+)、间接(-)。骨髓象:有核细胞增生明显活跃,中幼红细胞20.4％,晚幼红18.8％,可见花瓣形有核红细胞,嗜多染红细胞,全片上巨核细胞113个,幼巨核7％,颗粒型86％,产板型2％,裸核5％,血小板极少散在,诊断:甲状腺机能亢进伴Evans综合征。授予强的松治疗有效。
Kwak, female, 50 years old, palpitations, fear of heat, diarrhea, daily weight loss March, diagnosed in a medical school as hyperthyroidism, taking methimazole at the same time in February due to complications with dizziness, nasal bleeding and gums in May 18, 1987 live in our hospital. Physical examination: T37.7 ℃, P94 times / min, BP124 / 70mmHg, weight 38kg. Anemia appearance, scleral yellow dye. Thyroid enlargement, smell and vascular murmur. Qi heart. Liver not touched, liver ribs 2cm. Hand tremor (+). Assay: hemoglobin 61g / L, white blood cells 4.6 × 10 / L, reticulocyte 10%, platelet 21 × 10g / L, total bilirubin 41nmol / L, SGPT normal. HBsAg (-), urinary bilirubin (-), urobilinogen positive 1:20 (-), T_38.74nmol / L, T_4182nmol / L, Ham test (-), Coombs test direct ). Bone marrow: nucleated cell proliferation was significantly active, 20.4% of young erythrocytes, late browning of 18.8%, showing a petal-shaped nucleated erythrocytes, polychromatic erythrocytes, monolith megakaryocytes 113, juvenile megakaryocyte 7%, granular 86% , 2% of plate-producing type, 5% of bare nucleus, platelets rarely scattered, diagnosis: hyperthyroidism with Evans syndrome. Give prednisone treatment effective.