188543380
NVH
24217709
06/07/2000 12:00:00 AM
CHRONIC MYELOGENOUS LEUKEMIA
Signed
DIS
Admission Date :
06/07/2000
Report Status :
Signed
Discharge Date :
07/02/2000
PRINCIPAL DIAGNOSIS :
CML .
OTHER DIAGNOSES :
1. STATUS POST BONE MARROW TRANSPLANT .
2. INTRAPARENCHYMAL BLEED .
HISTORY OF PRESENT ILLNESS :
Mr. Larsen was a 50-year-old salesman who in 12/26 was noted to have an elevated platelet count of 778,000 .
He was found to have CML .
He was admitted on 06/07/00 for a matched , unrelated donor bone marrow transplant .
PHYSICAL EXAMINATION :
Unremarkable .
LABORATORY DATA :
White blood cell count of 24.409 and platelets of 956,000 .
HOSPITAL COURSE :
The patient received his bone marrow transplant on 06/12/00 .
His course was then complicated by fevers and neutropenia which were treated with antibiotics and a diffuse erythroderm felt to be a drug reaction .
On 06/24/00 the patient was found to have pulmonary infiltrates and some hemoptysis .
A bronchoscopy was done and there was blood found in the upper airways but no evidence of blood in alveoli so it was not felt to be DAH .
On 06/26/00 due to agitation , change in mental status and increased respiratory distress , the patient was intubated .
It was felt at that time that the changing mental status and respiratory distress might be due to a combination of medication and worsening mucositis .
Although the patient 's pain and sedation meds were adjusted he continued to be agitated and there was difficulty weaning him off the vent .
Because of this continued agitation , a head CT was performed on 07/01/00 and it revealed an intraparenchymal hemorrhage .
Neurosurgery was consulted but due to the severity of the bleed surgery was not considered an option .
The patient gradually lost brain systolic ejection murmur function and was pronounced dead on 07/02/00 .
Dictated By :
LAYMIE LARSEN , M.D. EM08
Attending :
ANA V. A , M.D. ZM0 LB414/6537
Batch :
67043
Index No.
EZCDQ560N8
D :
07/19/00
T :
07/20/00