老人貧血個案報告－以腸胃道出血表現之老人淋巴癌

Case Report: An Aged person Who Was Diagnosed of Lymphoma Representing with Upper Gastrointestinal Bleeding

10.29461/TGG.201408_9(3).0006

廖妙淯(Miao-Yu Liao)；林俊良(Chun-Liang Lin)；廖俊正(Chun-Cheng Liao)；李孟智(Meng-Chih Lee)

貧血 ； 老人 ； 淋巴癌 ； Anemia ； elderly ； lymphoma

台灣老年醫學暨老年學雜誌

9卷3期（2014 / 08 / 01）

127 - 135

繁體中文

一位66歲男性自2個月前開始覺得全身無力，每日活動量減少，沒有體重減輕也沒有夜間盜汗，但最近三週有間歇性解黑便，平常心跳每分鐘約90下，且走路會喘，故來本院門診求診。身體理學檢查結果除脾臟理學檢查為重度腫大，肛門指診有黑便，其餘無明顯異常，門診抽血檢查結果呈現：血色素為：6.3 g/dl、平均紅血球體積：79 fl、血小板：106×10^3/uL；因平均紅血球體積為79 fl為小球性貧血，其鐵蛋白值偏低故為缺鐵性貧血。其他檢驗結果如肝功能如（麩氨基酸草醋酸轉氨基酵素／麩氨基酸焦葡萄轉氨基酵素）值為23/22 U/L、尿酸值為7.2 mg/dl、三酸甘油酯值為108 mg/dl，而乳酸脫氫脢、紅血球沈降速率為正常。病人住院做進一步檢查，因有解黑便，胃鏡檢查為表淺性胃炎及十二指腸潰瘍並做切片，胃鏡切片報告為胃淋巴癌。會診血液科並做骨髓切片其結果為malignant non-Hodgkin lymphoma，stage IV diffuse large B-cell lymphoma，目前持續接受化療中。此個案本為腸胃道出血表現之貧血，最後確診為淋巴癌。老年人貧血需要想到有可能會有惡性腫瘤，故老人家的病史詢問及理學檢查及相關鑑別診斷是非常重要。

A 66 year old male suffered from general weakness and decreased activities of daily living in the recent three weeks. When he came to our out-patient department, the physical examination showed no definite finding except severe palpable spleen. No pitting edema was found over the bilateral lower limbs. The laboratory data showed anemia (hemoglobin: 6.3 g/dl) and thrombocytopenia (platelet count: 106×10^3/dl). Owing to anemia, thrombocytopenia, and splenomegaly, he was admitted for further evaluation and treatment. Abdominal sonography was arranged and it showed no significant finding except severe splenomegaly. Abdominal computer tomography was also done and lymphoceles or cystic lymphangiomias in the mesentery could not be ruled out. We also arranged a gastroscopic examimation because of epigastric pain. Initial reports showed superficial gastritis and duodenal ulcer. Finally, the report of biopsy revealed lymphoma (gastric Lymphoma) came three days later. Bone marrow biopsy was also done and it showed malignant lymphoma (diffuse large B cell type with bone marrow infiltration). The patient received chemotherapy regularly at the Hematology OPD until Now.