GROUP 2

Athaya hafizhah
Fathimah azzahra
Renggo aning saputri
Wulandari
Zahrotul jannah
 A 74 year old african american woman enters
your office with the complaint that she has been
developing bruises all over her axtremities for
the last several days. She also has noticed that
her stool seems to be a lot darker. She
describes it looking almost like coffee grounds.
She relocated to your area to live with her
daughter after her home in galveston was
destroyed several months ago. This is her initial
visit to your office, as she had refills available
for all of her medications and previously felt
fine.
 Her past medical history is notable for being
hypertensive, postmenopousal, having an
irregular heartbeat thath she doesnt remember
the exact name for, and having a touch of
diabetes and arthritis. Her prescribed
medications are hydrochlorothiazide and
warfarin. Her over-the-counter medications
include aspirin which she started taking since
moving to your city, a multivitamin,
acetaminophen for her arthritis and ibuprofen
for when her knees really bother her. She also
admits to regularly drinking herbal teas.
 KEY WORD
1. A 74 year old
2. Bruises all over her axtremities
3. Stool seems to be a lot darker
4. Past medical history is notable for being hypertensive,
postmenopousal
5. Having an irregular heartbeat
6. She doesnt remember the exact name
7. Having a touch of diabetes and arthritis
8. Her prescribed medications are hydrochlorothiazide and warfarin
9. Her over-the-counter medications include aspirin,multivitamin,
acetaminophen
10. She has take an ibuprofen for her knees
11. Regularly drinking herbal teas
 DIFFERENTIAL DIAGNOSE

1. Hematologic disease cause drug induced

2. Liver disease
3. Hemophilia
4. Von willebrand disease
HEMATOLOGIC DISEASE CAUSE
DRUG INDUCED
Induced by drugs which can disturb hemostatic.
In this case is caused by interaction of aspirin and
warfarin.
- Disfunction of trombosit

Symptoms:
- Easy to bleeding -> easily bruising
- Melena
- Trombositophenia
 LIVER DISEASE

Occurs when large part of the liver become damage beyond repair
and the liver is no longer able to function.

Symptoms:
- Jaundice
- Bleeding easily
- Lost of appetite
- Fatigue
- diarrhea
 HEMOPHILIA

Recessive disorders caused by deficiency of functional plasma

clotting factor VIII (anti-hemophili) which may be inherited or
arise from spontaneous mutation.
Common in infants.

Symptoms:
- Hematoma leading to location-specific signs
 VON WILLEBRAND DISEASE

Is a common inherited genetically and clinically heterogeneous

hemorrhagic disorders caused by a deficiency or disfunction of the
protein termed vWF.
Move pronounced in females
Young age
Symptoms:
- Easy bruising
- Prolonged bleeding
- Exacerbation of bleeding symptoms (after ingestion of aspirin)
 IDENTITY

Surname : -
First name : A
Age : 74 yo
Sex : Female
Marital Status :-
 PRESENT COMPLAINT

1. Bruises all over the axtremities for the last

several days
2. She also has noticed that her stool seems to
be a lot darker, it looking almost like coffee
grounds
 ON EXAMINATION

1. General condition :-
2. ENT :-
3. RS :-
4. CVS : an irregular heartbeat
5. GIS : dark stool (melena)
6. GUS :-
7. CNS :-
 EXAMINATIONS

Height
Weight
Estimation of blood pressure
Examination from head to toes
Examination of rectum (rectal touche)
Head to toes
Found :

Rectal
touche
found :
 IMMEDIATE PAST HISTORY
1. Her past medical history is notable for being
hypertensive, postmenopousal, having an irregular
heartbeat thath she doesnt remember the exact name
for, and having a touch of diabetes and arthritis.
2. Her prescribed medications are hydrochlorothiazide
and warfarin.
3. Her over-the-counter medications include aspirin
which she started taking since moving to your city, a
multivitamin, acetaminophen for her arthritis and
ibuprofen for when her knees really bother her.
4. She also admits to regularly drinking herbal teas.
POINTS OF NOTE

No information
 INVESTIGATION
1. Complete blood count :
Blood sample for haemoglobin
Blood sample for trombosit
Blood sample for blood group
2. Chemical blood count
3. Liver function
4. Kidney function include urin
5. Electrocardiography for her irregular heartbeat
6. Fecal occult blood test
7. Prothrombin Time (PT)
 DIAGNOSIS

Hematologic disease cause drug induced

 MANAGEMENT
1. Thrombosit transfussion
2. Pharmacology :
- Insulin for diabetic
- Hydrochlorothiazid for hypertension
3. Education :
- Dont carelessly buy over-the-counter drugs
- Avoid trauma
- Dont consumed herbal teas and warfarin
- Drink water plenty