BOLESNIK S MIJELODISPLASTIČNIM SINDROMOM U HITNOJ SLUŽBI

Ingrid Prkačin, Inga Mandac Rogulj, Višnja Mandac Bajan, Ana Planinc Peraica, Gordana Cavrić, Dean Mileta

Mijelodisplastični sindrom (MDS) grupa je klonskih mijeloidnih poremećaja s heterogenom kliničkom slikom, a najveći broj komplikacija posljedica je citopenija koje su karakteristično obilježje. Etiologija nije dovoljno poznata. Internacionalni bodovni sustav (engl. The International Prognostic Scoring System – IPSS) služi kao prognostički čimbenik za neliječene bolesnike s MDS-om. Nedjelotvorna hematopoeza, pa tako i eritropoeza, dovode do anemije, što je najčešći uzrok dolaska bolesnika s MDS-om u hitnu službu. Vrlo često bolesnici imaju brojna pridružena stanja poput kronične bubrežne bolesti i hipertenzije, a mogu imati i kliničku sliku akutnoga koronarnog sindroma. Prikazujemo 83-godišnju bolesnicu s MDS-om dijagnosticiranim 2014. godine i koja dosad nije liječena specifičnom hematološkom terapijom. Zbrinjavanje starijih hematoloških bolesnika u hitnoj službi nalaže sveobuhvatni pristup zbog često prisutnih pridruženih stanja koja se dodatno mogu pogoršati uz MDS.

Myelodysplastic syndromes (MDS) are a group of clonal disorders arising from hematopoietic stem cells and are generally characterized by inefficient hematopoiesis and dysplasia. The International Prognostic Scoring Sytem (IPSS) is an important standard for assessing prognosis of primary untreated adult patients with myelodysplastic syndromes (MDS). Ineffective hematopoiesis leading to anemia is the most common cause of the arrival of patients with MDS in the emergency room . Patients with MDS have a number of associated conditions such as chronic kidney disease and hypertension, and may be present as acute coronary syndrome. We report a case of a 83-year-old female with MDS that was diagnosed in 2014 and had no specific treatment. She presented to the emergency department at the beginning of 2016 because of epigastric and chest pain that began in the morning. Diagnosis of subacute STEMI with a scar formed on front wall and elevated high-sensitivity troponin (hsTnI) which amounted to 1,369 ng / L (reference value < 15.6 ng / L) was made, and the patient was hospitalized in the Coronary Care Unit . The care for this population of patients, mainly elderly, in the emergency department requires a comprehensive approach due to the presence of associated conditions such as hypertension, chronic kidney disease and ischemic heart disease. Cardiovascular diseases (CVD) are the leading cause of death in all countries worldwide.