leucemii, coagulare doc

7/23/2019 Leucemii, Coagulare Doc

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CUPRINS LEUCEMII

LEUCEMII......................................................................................................................................................1ClasificareClasificare........................................................................................................................................................3LEUCEMII ACUTE........................................................................................................................................3

Definitie.......................................................................................................................................................3Clasificare....................................................................................................................................................3Simptomatologie..........................................................................................................................................3

1. Sindrom anemic1. Sindrom anemic...........................................................................................................................................32. Sindrom infectios2. Sindrom infectios.........................................................................................................................................33. Sindrom hemoragic3. Sindrom hemoragic......................................................................................................................................3

Simptome de localiare................................................................................................................................3Simptome de localiare................................................................................................................................3

E!amen hematologicE!amen hematologic......................................................................................................................................."A.A. Sange perifericSange periferic........................................................................................................................................."B.B. Maduva osoasaMaduva osoasa........................................................................................................................................."LAL.................................................................................................................................................................."LAM................................................................................................................................................................"LEUCEMIE MIEL#IDA C$#%ICA.............................................................................................................."

Definitie......................................................................................................................................................."Simptomatologie.........................................................................................................................................."

I.I. Examen hematologic................................................................................................................................&II.II. Alte investigatii.........................................................................................................................................&LEUCEMIA LIM'ATIC( C$#%ICA............................................................................................................&

Definitie.......................................................................................................................................................&Simptomatologie..........................................................................................................................................&I. E!amen hematologic................................................................................................................................)II. Alte in*estigatii........................................................................................................................................)

+#ALA ,#D-I%........................................................................................................................................)Definitie.......................................................................................................................................................)

Simptomatologie //............................................................................................................................................)1.1. Determinari in organe limfaticeDeterminari in organe limfatice...............................................................................................................)2.2. Determinari in organe nelimfaticeDeterminari in organe nelimfatice...........................................................................................................03. Manifestari generale /3. Manifestari generale /..................................................................................................................................0

In*estigatii paraclinice.................................................................................................................................0I.I.Biopsia ganglionara.....................................................................................................................................0I.I.Examen hematologic....................................................................................................................................03. Alte investigatii3. Alte investigatii...........................................................................................................................................0

Stadialiare/..................................................................................................................................................0LIM'#MUL %#% ,#DI%..........................................................................................................................

Diagnostic si stadialiare.............................................................................................................................MIEL#MUL MULTILU...............................................................................................................................

Simptome.....................................................................................................................................................Diagnostic paraclinic....................................................................................................................................

SI%D$#AME ,EM#$A-IA$E.................................................................................................................I.I. P!P!E "AS#$A!EP!P!E "AS#$A!E.........................................................................................................................II.II. SI%D!&AME 'EM&!A(IPA!E P!I% )!&MB&PE%II SI * SA )!&MB&PASI%D!&AME 'EM&!A(IPA!E P!I% )!&MB&PE%II SI * SA )!&MB&PATIITII..............................

III.III. #&A($&PA)II#&A($&PA)II..................................................................................................................................U$U$A ,E%#C, SC,%LEI%..............................................................................................................

Etiologie.......................................................................................................................................................Semiologie/..................................................................................................................................................4

In*estigatii paraclinice.................................................................................................................................4I.I. Examen hematologicExamen hematologic................................................................................................................................4II.II. Alte investigatiiAlte investigatii.........................................................................................................................................4

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U$U$ELE T$#M+#CIT#E%ICE.........................................................................................................4Ca5e............................................................................................................................................................4Etiopatogenea.............................................................................................................................................4Semne clinice...............................................................................................................................................4

1616 hemoragii cutanatehemoragii cutanate...................................................................................................................................42626 hemoragii mucoashemoragii mucoase 7 epista!ise 7 epista!is.................................................................................................................4

Semne hematologice..................................................................................................................................18U$U$A T$#M+#E%ICA IDI#ATICA 9 +#ALA :E$L,#' 6......................................................18

Etiopatogenea...........................................................................................................................................18Simptomatologie........................................................................................................................................18E!amen hematologic..................................................................................................................................18

T$#M+ASTE%II..........................................................................................................................................18Definitie.....................................................................................................................................................18Clasificare..................................................................................................................................................18Simptomatologie........................................................................................................................................18E!amen hematologic..................................................................................................................................18

,EM#'ILII...................................................................................................................................................18Definitie.....................................................................................................................................................18Clasificare..................................................................................................................................................18

Istoric.........................................................................................................................................................18Simptomatologie........................................................................................................................................18In*estigatii paraclinice...............................................................................................................................11

C#A-ULA$E I%T$A;ASCULA$A DISEMI%ATA.................................................................................11Definitie......................................................................................................................................................11Etiologie.....................................................................................................................................................11Simptomatologie........................................................................................................................................11

I.I. +a,a de hipercoagula-ilitate+a,a de hipercoagula-ilitate..................................................................................................................11II.II. +a,a de hipocoagula-ilitate+a,a de hipocoagula-ilitate...................................................................................................................11

Manifest


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snge alb

ClasificareClasificare

ACUTE CRONICEOrigine mieloida LAM LMCOrigine limfoida LAL LLC

LEUCEMII ACUTE

Defnitie> ?oala neoplaica caracteriata prin proliferarea maligna a cel5lelor tinere aflate in primele stadii de> ?oala neoplaica caracteriata prin proliferarea maligna a cel5lelor tinere aflate in primele stadii dediferentiere mieloida sa5 limfatica si infiltratia mad5*ei osoase.diferentiere mieloida sa5 limfatica si infiltratia mad5*ei osoase.

Clasifcarele5cemie ac5ta mielo?lasticale5cemie ac5ta mielo?lastica> le5cemie ac5ta limfo?lastica> le5cemie ac5ta limfo?lasticaSimptomatologie

De-utDe-ut

?r5sc?r5sc fe?rafe?ra

alterarea starii generalealterarea starii generale sindrom hemoragiparsindrom hemoragiparStareStare

1. Sindrom anemic1. Sindrom anemic paloarepaloare cefaleecefalee ameteliameteli astenieastenie dispneedispnee s5fl5ri sistolices5fl5ri sistolice

2. Sindrom infectios2. Sindrom infectios

fe?ra ridicatafe?ra ridicata lei5ni 5lceronecrotice ale > m5coasei ?5cale@ amigdalelorlei5ni 5lceronecrotice ale > m5coasei ?5cale@ amigdalelor infectiiinfectii

c5tanatec5tanate respiratoriirespiratorii 5rinare5rinare

3. Sindrom hemoragic3. Sindrom hemoragic hemoragii c5tanate si m5coasehemoragii c5tanate si m5coase

Simptome de localizare AdenopatiiAdenopatii

generaliategeneraliate marime red5samarime red5sa consistenta 5sor cresc5taconsistenta 5sor cresc5ta ned5reroasaned5reroasa neaderenta la plan5rile prof5nde teg5menteneaderenta la plan5rile prof5nde teg5mente

'epatomegalie'epatomegalie7 moderata7 moderata SplenomegalieSplenomegalie

moderatamoderata fermaferma netedaneteda reg5latereg5late

Simptome de localizare

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determinari osoase si osteoartic5laredeterminari osoase si osteoartic5lare d5reri artic5lared5reri artic5lare t5mefiere artic5larat5mefiere artic5lara

determinari meningocere?raledeterminari meningocere?rale hemoragie cere?ralhemoragie cere?ral paraliii de ner*i cranieniparaliii de ner*i cranieni meningitemeningite

determinari c5tanatedeterminari c5tanate

nod5lenod5le er5ptii de tip r5?eliformer5ptii de tip r5?eliform

determinari oc5laredeterminari oc5lare t5l?5rari de *ederet5l?5rari de *edere modificari ale f5nd5l5i de ochimodificari ale f5nd5l5i de ochi

infiltrate p5lmonare ple5reieinfiltratep5lmonare ple5reie gingi*ita hipertroficagingi*ita hipertrofica

E!amen hematologicE!amen hematologicA.A. Sange perifericSange periferic

Serie al?aSerie al?a

in f5nctie de n5mar5l de -A siprocent5l de ?lastiin f5nctie de n5mar5l de -A siprocent5l de ?lasti le5cemicale5cemica s5?le5cemicas5?le5cemica ale5cemicaale5cemica

mielo?lasticamielo?lastica mielo?lasti atipici paramielo?lastimielo?lasti atipici paramielo?lasti BBhiat5s le5cemichiat5s le5cemic

limfo?lastica > limfo?lasti atipicilimfo?lastica > limfo?lasti atipici Serie rosie > anemie normocroma @normocitaraSerie rosie > anemie normocroma@normocitara Serie trom?ocitara 7 trom?openieSerie trom?ocitara 7 trom?openie

B.B. Maduva osoasaMaduva osoasaproliferare de ?lasti le5cemiciproliferare de ?lasti le5cemici hipoplaia importanta a celorlalte seriihipoplaia importanta a celorlalte serii

LAL Cea mai frec*ent< afeci5ne malign< la copil $a adult 2/ din $A

Afectare frecvent0 a S% 1 puncie lom-ar0 o-ligatorie

LAMM8/ difereniere minim mica moderataoliadenopatie > mica moderata

Manifestari c5tanateManifestari c5tanate le5cemidele5cemide hemoragii @ rashhemoragii @ rash

Infiltrate leucemiceInfiltrate leucemice> foarte rar> foarte rarI. Examen hematologic

1616 Sange perifericSange periferic Serie al?aSerie al?a

-.A > 188.888 > 388.888 mmc-.A > 188.888 > 388.888 mmc scaderea gran5locitelor ne5trofile si limfocitelorscaderea gran5locitelor ne5trofile si limfocitelor cresterea eoinofilelor si ?aofilelorcresterea eoinofilelor si ?aofilelor

> preenta de elemente tinere > metamielociti @ mielociti> preenta de elemente tinere > metamielociti @ mielociti Serie rosie > anemie moderata > normocroma @ normocitaraSerie rosie > anemie moderata > normocroma @ normocitara Serie trom?ocitara > trom?ocitoa > Tr &88.888 > )88.888 mmSerie trom?ocitara > trom?ocitoa > Tr &88.888 > )88.888 mm

2626 Mad5*a osoasaMad5*a osoasa > 8 > 48 N elemente gran5locitare> 8 > 48 N elemente gran5locitare > dimin5area eritro?lastilor> dimin5area eritro?lastilor > n5meroase megacariocite> n5meroase megacariocite

II. Alte investigatii1616 cromoom Bhiladelphiacromoom Bhiladelphia2626 fosfataa alcalina le5cocitara 7 sca5tafosfataa alcalina le5cocitara 7 sca5ta

3636

LD,@ ac 5ric cresc5tLD,@ ac 5ric cresc5t

LEUCEMIA LIMFATIC CRONICADefnitie

proliferarea neoplaica a cel5lelor ad5lteproliferarea neoplaica a cel5lelor ad5lte mai frec*enta la ?ar?ati @ d5pa &8 animai frec*enta la ?ar?ati @ d5pa &8 ani

Simptomatologie44 AdenopatiiAdenopatii

generaliategeneraliate periferice si prof5ndeperiferice si prof5nde ?ilaterale si s?ilaterale si siimetricemetrice mo?ile @ ned5reroasemo?ile @ ned5reroase consistenta moaleconsistenta moale

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2424 SplenomegalieSplenomegalie

netedaneteda ned5reroasaned5reroasa mo?ilemo?ile moderatamoderata

3434 'epatomegalie'epatomegalie77 moderatamoderata5454 Sindrom Mic6ulic,Sindrom Mic6ulic,

hipertrofie simetrica a glandelor lacrimale si parotidehipertrofie simetrica a glandelor lacrimale si parotide

7474 Manifestari cutanateManifestari cutanate le5cemidele5cemide eritrodermie 9Bom ros56eritrodermie 9Bom ros56 rashrash p5rp5rap5rp5ra echimoeechimoe mOcosis f5ngoidesmOcosis f5ngoides pr5rit intens lei5ni de grataPpr5rit intens lei5ni de grataP

8484 Manifestari pulmonareManifestari pulmonare

infectii ?ronhop5lmonareinfectii ?ronhop5lmonare

9494 Semne generaleSemnegenerale astenieastenie s5?fe?rilitates5?fe?rilitate transpiratiitranspiratii

:4:4 Manifestari oculare ;nervoase ; osteoarticulare si renaleManifestari oculare ;nervoase ; osteoarticulare si renale

I. Examen hematologic. Sange periferic

Serie al-aSerie al-a hiperle5cocitoa > -.A. &8.888>1&8.888 mmchiperle5cocitoa > -.A. &8.888>1&8.888 mmc limfocitoa > 8Nlimfocitoa > 8N

5m?re cel5lare -5mprecht5m?re cel5lare -5mprecht Serie rosieSerie rosie>> anemie moderata@ normocroma@ normocitaraanemie moderata@ normocroma@ normocitara Serie trom-ocitaraSerie trom-ocitara>> trom?ocitopenie n5mar normaltrom?ocitopenie n5mar normal

2. Maduva osoasa

infiltatia mad5*ei c5 limfocite > &8>48Ninfiltatia mad5*ei c5 limfocite > &8>48N scadere relati*a pe celelalte linii cel5larescadere relati*a pe celelalte linii cel5lare

II. Alte inestigatii fosfataa alcalina le5cocitara > normala cresc5tafosfataa alcalina le5cocitara > normala cresc5ta hiphipoogamaglo?5linemiegamaglo?5linemie

!ani"est#ri a$toim$ne

Anemie hemolitic


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ned5reroasened5reroase consistenta fermaconsistenta ferma neaderenteneaderente n5 5lcereaan5 5lcereaa mase t5moralemase t5morale

d5rere d5p< ingestia de alcoold5rere d5p< ingestia de alcoolprof5ndeprof5nde mediastinalemediastinale

t5se iritati*at5se iritati*a dispneedispnee compresi5ne pe ;CScompresi5ne pe ;CS

a?dominalea?dominale> fenomene de compresi5ne> fenomene de compresi5ne?6?6 SplenomegalieSplenomegalie

preenta in &8N din ca5ripreenta in &8N din ca5ri moderatamoderata

2.2. Determinari in organe nelimfaticeDeterminari in organe nelimfatice

ple5rop5lmonareple5rop5lmonare ple5reieple5reie

infiltrate p5lmonareinfiltrate p5lmonare cardiacecardiace

t5l?5rari de ritmt5l?5rari de ritm pericarditapericardita

ne5rologicene5rologice osoase > d5reri osoase spontane la compresi5neosoase > d5reri osoase spontane la compresi5ne digesti*e > in special hepaticedigesti*e > in special hepatice renalerenale c5tanatec5tanate99ichtio


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Serie al?aSerie al?a -.A. de o?icei normal-.A. de o?icei normal 5neori le5cocitoa moderata5neori le5cocitoa moderata rar le5copeniarar le5copenia ne5trofilie @ eoinofilie @monocitoa @ limfopeniene5trofilie @ eoinofilie @monocitoa @ limfopenie

Serie trom?ocitara > Tr de o?icei normaleSerie trom?ocitara > Tr de o?icei normale2. Maduva osoasa2. Maduva osoasa > aspect normal> aspect normal3. Alte investigatii3. Alte investigatii

;S, fi?rinogen 7 cresc5te;S, fi?rinogen 7 cresc5te hipergamaglo?5linemiehipergamaglo?5linemie ID$ la t5?erc5lina 7 negati*eID$ la t5?erc5lina 7 negati*e

Stadializare:Stadi5l I / 5n sing5r gr5p ganglionar 9I6 sa5 organ e!tralimfatic 9IAE 6Stadi5l II / 2 sa5 mai m5lte gr5pe ganglionare 9II6 sa5 organ e!tralimfatic de aceeai parte adiafragm5l5iStadi5l III / Interesarea am?elor p38N.Simptome

16 Manifest0ri datorate prolifer0rii tumorale/ d5reri osoase@ deform


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Electrofore< *Krf ?eta gama@ Ig - 9A@ D6 r>5rie +ence =ones calcemiei Lei5ni osteolitice 5ncie med5lar


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> sediment 5rinar 7 hemat5rie> sediment 5rinar 7 hemat5riePURPURELE TROMBOCITOPENICE

Ca$ze trom?openietrom?openie trom?opatietrom?opatie

Etiopatogeneza distr5gerea Tr.distr5gerea Tr. mecanismmecanismim5nologic 7 a5toanticorpiim5nologic 7 a5toanticorpi

ioanticorpiioanticorpi mecanismmecanismneim5nologic 7 CIDneim5nologic 7 CID deficit de prod5cere a Tr. > agenti fiici @ chimicideficit de prod5cere a Tr. > agenti fiici @ chimici

Afecti5ni care e*ol5eaa c5 p5rp5re trom?ocitopenice/Afecti5ni care e*ol5eaa c5 p5rp5re trom?ocitopenice/ hipersplenismhipersplenism alcoholismalcoholism le5coe > ac5te cornicele5coe > ac5te cornice l5p5s eritematos diseminatl5p5s eritematos diseminat infectii *iraleinfectii *irale

Semne clinice

44 hemoragii cutanatehemoragii cutanate petesiipetesii echimoeechimoe

2626 hemoragii mucoashemoragii mucoase 7 epista!ise 7 epista!is gingi*oragiigingi*oragii hemoragii digesti*ehemoragii digesti*e metroragiemetroragie

Semne hematologicetrom?openie 9V &8.888 mmc6trom?openie 9V &8.888 mmc6TS prel5ngitTS prel5ngit

PURPURA TROMBOPENICA IDIOPATICA ( BOALA WERLHOF )Etiopatogeneza mecanism a5toim5n declansat de infectii *irale ?acteriologicemecanism a5toim5n declansat de infectii *irale ?acteriologice

Simptomatologie p5rp5ra c5tanata @ hemoragii m5coasep5rp5ra c5tanata @ hemoragii m5coase splenomegalie moderata 913 din ca5ri6splenomegalie moderata 913 din ca5ri6Examen hematologic

,?. @ ,t. @ n5mar5l E. > normale sca5te 9hemoragiimportante6,?. @ ,t. @ n5mar5l E. > normale sca5te 9hemoragiimportante6 n5mar5l -.A. > normal cresc5tn5mar5l -.A. > normal cresc5t n5mar5l Tr. > sca5t 9 V &8.888 mmc6n5mar5l Tr. > sca5t 9 V &8.888 mmc6

TS 7 prel5ngitTS 7 prel5ngit TC@ T 7 normaleTC@ T 7 normale pro?a garo5l5i poiti*apro?a garo5l5i poiti*a med5lograma > n5mar normal cresc5t demegacariocitemed5lograma > n5mar normal cresc5t demegacariocite

TROMBASTENIIDefnitie anomalii f5nctionale ale Tr.anomalii f5nctionale ale Tr. deficite de adei*itatedeficite de adei*itate deficite de agrega?ilitatedeficite de agrega?ilitateClasifcare

castigate 7 5remiacastigate 7 5remia ciroaciroa le5cemie mieloida cronicale5cemie mieloida cronica

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congenitala > trom?astenia ereditara-lanmanncongenitala > trom?astenia ereditara-lanmannSimptomatologie

p5rp5ra c5tanatap5rp5ra c5tanata hemoragii m5coasehemoragii m5coase

Examen hematologic n5mar5l Tr. 7 normaln5mar5l Tr. 7 normal TS 7 sca5tTS 7 sca5t

HEMOFILII

Defnitie ?oala ereditara?oala ereditara transmitere gonoomal recesi*atransmitere gonoomal recesi*a afectarea 9aproape6 e!cl5si*a a ?ar?atilorafectarea 9aproape6 e!cl5si*a a ?ar?atilorClasifcare hemofilia A > lipsa factor5l5i ;III 9glo?5linaantihemofilica6hemofilia A > lipsa factor5l5i ;III 9glo?5linaantihemofilica6 hemofilia + > lipsa factor5l5i IW Christmashemofilia + > lipsa factor5l5i IW Christmas hemofilia C > lipsa factor5l5i WIhemofilia C > lipsa factor5l5i WIIstoricSec 2 $a?inii e!cepta5 de la circ5mciie 5n ? echimoe 9 n5 petesii6hemoragii c5tanate > echimoe 9 n5 petesii6 hematoame s5?c5tanatehematoame s5?c5tanate mai rar hemoragiimai rar hemoragii

m5sc5lare > psoas @ fesierim5sc5lare > psoas @ fesieri digesti*edigesti*e renalerenale

Inestigatii paraclinice TC prel5ngitTC prel5ngit TS @ T 7 normaleTS @ T 7 normale n5mar5l Tr. > normaln5mar5l Tr. > normal

COAGULARE INTRAVASCULARA DISEMINATADefnitieafecti5ne caracteriata prin asociere9parado!ala6 de trom?oe si hemoragiiafecti5ne caracteriata prin asociere9parado!ala6 de trom?oe si hemoragiiEtiologie

septicemia c5 -ram negati*esepticemia c5 -ram negati*e

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soc endoto!icsoc endoto!icle5cemiile5cemiiinter*entii chir5rgicale mariinter*entii chir5rgicale maricancerecancereem?oli gaoaseem?oli gaoase

SimptomatologieI.I. +a,a de hipercoagula-ilitate+a,a de hipercoagula-ilitate

coag5lare masi*a > formare de microtrom?i > infarctiari /coag5lare masi*a > formare de microtrom?i > infarctiari /

cianoa e!tremitatilorcianoa e!tremitatilor BBnas negr5nas negr5 p5rp5ra necroticap5rp5ra necrotica fenomene ne5rologicefenomene ne5rologice

cons5m e!agerat al factorilor coag5lariicons5m e!agerat al factorilor coag5lariiII.II. +a,a de hipocoagula-ilitate+a,a de hipocoagula-ilitate

hemoragii c5taneo>m5coasehemoragii c5taneo>m5coase hemoragii *isceralehemoragii *iscerale

digesti*edigesti*e respiratoriirespiratorii

renalerenale cere?ralecere?rale!ani"est#ri cliniceInestigatii paraclinice

n5mar5l de Tr. V 188.888 mmc6n5mar5l de Tr. V 188.888 mmc6 T > sca5t 9 V &8N6T > sca5t 9 V &8N6 fi?rinogen >sca5t 9 V2 g l6fi?rinogen >sca5t 9 V2 g l6 D' > cresc5tiD' > cresc5ti D dimeri cresc5tiD dimeri cresc5ti

LLC+@ &3 de aniClinic/ astenie@ adenopatii ned5reroase generaliate@ eritrodermie,? 11@ gN@ ,t "1N-A 08 888 mmc'L/ ne5trofile 1"N@ eoinofile 2N@ ?aofile 3N@ limfocite 00N@ monocite "NTrom?ocite 288 888 mmc

Bie!e'@ )8 de aniClinic/ cefalee@ *ertiP@ d5reri precordiale@ paresteii mem?rele inferioareE!. o?iecti*/ paloare@ lim?< roie@ neted


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+@ 10 aniClinic/ *ertiP@ paloare@ fe?rcer*icale,? gN-A )0 888mm3@ 'orm5l< le5cocitar< & N ?lati pero!idao>poiti*i@ 13N ne5trofile@ 3Neoinofile@ 1 N ?aofile@ 1&N limfocite@ 0 N limfocite@ 3N monociteTrom?ocite &) 888mm3

LMC

'@ &) aniClinic/ astenie@ s5?fe?rilitate@ d5reri Fn hipocondr5l stg,? 18@2 gN @ ,t 3N-A 288 888 mmc'orm5la le5cocitar


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Asig5ra repa5s la patre*ine inf.intraspitalicesti$ela!are artic.hemartoaAsig5ra igiena teg.si m5coase@pre*ine escare@alim ?.Monitorieaa T@p5ls@TA@respiratiiAn5nta aparitia elem hemoragiceComprese reci pe art. C5 hemoragiiDi5rea@hemat5rie

[email protected]/transf5ii sg.@fe@le5Heran@mileran@citostatice@*itC@S5stin psihic ?.@ Hinetoterapie

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leucemii, coagulare doc

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