Chapter One Hundred and Twenty-Three: Seeing and Hearing of Concord (Part 2)
Heparin is one of the final weapons for clinical anticoagulation treatment. Since the discovery of heparin in 1916, this magical extract has continued to play a major role in the field of human medicine. Especially in cardiac surgery and extracorporeal circulation, heparin
The use of heparin is extremely common. Unlike drugs such as antibiotics, heparin itself is also one of the mucopolysaccharide sulfates naturally secreted by the human body to control the speed of blood clotting. Therefore, heparin will not develop drug resistance due to overuse.
And it fails. If there are patients who are not sensitive to heparin, then the situation will become very difficult.
Especially when a patient suffering from pulmonary embolism becomes heparin insensitive, the situation becomes even more troublesome. Coumarin anticoagulants such as warfarin take effect too slowly, and heparin is generally required for clinical practice.
Anticoagulation is "pre-started" and then switched to warfarin to achieve the desired effect. Simply using warfarin is obviously not fast enough under the current circumstances.
As the pinnacle of Chinese medicine, the doctors at Union Medical College Hospital are basically the top figures. Even the chief resident of the emergency department who is studying for a doctorate can make a judgment immediately after discovering an abnormal situation. Yuan Pingan spent little effort.
I decided to ask the Department of Hematology for consultation. Li Songzhao’s situation was indeed somewhat abnormal.
It only took a few minutes for the hematology department to rush to the emergency room. After getting the patient's coagulation test report and listening to Sun Lien's description, the doctor from the hematology department immediately made suggestions. "Check his f-xiii coagulation factor immediately.
Let the comrades in the laboratory department work overtime, and we need to run an ELISA test."
Yuan Pingan frowned and said, "f-xiii?" He suddenly seemed to have understood something, and nodded and agreed to the examination request. After the doctor from the Department of Hematology left, he suddenly asked Sun Lien, "I see on Liuxiang Garden
"I said Dr. Xiao Sun is a good doctor at diagnosis." He pointed at Li Songzhao, who was lying on the bed with a pale face, and asked, "What kind of disease do you think this patient has?"
Sun Lien had been working all day today. After being pinched for a long time on a plane, he had no place to rest when he landed. He stayed up all night at an Internet cafe and discovered a seriously ill patient. After going through this series of things, his brain had long since gone numb.
He deliberately shied away and said, "There are too many big names in Xiehe, so it's not my turn to talk nonsense here. You can make your own judgment. The most I can do is visit."
"It seems that Dr. Sun is not willing to deal with an emergency doctor like me who has become a monk by the wayside." Yuan Ping'an took out all his grievances about missing Liu Pingchuan on Sun Lien, and even Ningyuan Medical College was hated by him.
"Or is it that Xiehe is no longer important in your hospital's eyes, and the nature of the case is no longer even discussed?"
Sun Lien has been a training student for two months and has seen many kinds of people in the emergency room, but this is the first time he has seen such an aggressive colleague. He frowned and said, "Dr. Yuan, I'm just a training student.
I don’t have a medical practitioner qualification certificate, so I can’t carry out medical activities here.”
"It's just a discussion." Yuan Pingan spread his hands. Communication between doctors is a very common thing. Even if it looks like he is bullying others, Yuan Pingan just wants to punish the little Gu Pei in front of him who is blown to be House.
He humiliated him hard and told him with practical actions that medical treatment relies on professional knowledge and a large number of case experiences, rather than some juggling diagnosis. In his opinion, Sun Lien is just a lucky guy. Sun Lien diagnosed
The disease is not a particularly rare disease, but the patient's symptoms are unique.
Li Songzhao's disease is probably a truly rare disease. The doctor in the hematology department asked for an ELISA test, which already prompted the specialist's suspicion. This disease is so rare that Yuan Ping'an would not have studied it during his postgraduate period.
After passing the ELISA technology and hearing about this detection method from the guidance expert, he would not even know the existence of this disease.
ah x iii. The full name is "autoimmune haemorrhaphilia factor x3" (autoimmune haemorrhaphilia factor
5 cases have been diagnosed.
How can a young man who has been trained for two months and not even have the qualifications to practice medicine try to make a difference in diagnosis? Yuan Pingan almost laughed out loud. I'm afraid even your instructor has never seen this kind of rare disease.
Come on! How can you diagnose a disease you have no way of knowing about?
Sun Lien looked at Li Songzhao lying on the hospital bed and felt a little anxious. He didn't think that the Union Medical College could not diagnose Li Songzhao's condition. Yuan Pingan's behavior was naturally causing problems for himself. What Sun Lien was worried about was that when the symptoms of pulmonary embolism were clear,
Yuan Pingan was still in the mood to cause problems for himself, but did not take any treatment measures.
"If you confirm the diagnosis, you should treat him first." Sun Lien sighed, "The communication can wait until the patient's condition stabilizes."
"His condition is quite stable. It takes about three hours for the ELISA test to produce results. Before the results come out, other treatment methods are meaningless." Yuan Pingan spread his hands indifferently, "It would be better if Dr. Sun could make a diagnosis as soon as possible.
If so, maybe we will have more suitable treatment methods!"
Sun Li'en looked at Yuan Pingan, and suddenly felt annoyed. "I am not a doctor just to be in the spotlight!" He looked at Yuan Pingan and said coldly. Then he put his backpack behind the duty desk and said, "Medical skills
Under the brocade banner of "Exquisite, wonderful rejuvenation". He hung his coat on the clothes rack, picked up a white coat and put it on, "Since Dr. Yuan wants to communicate, let's have a good communication!"
Part of Sun Lien's courage to challenge the Union Medical College Emergency Doctor comes from his status, and the other part comes from his ideals for the doctor's profession. Competing based on the patient's condition? This is not the 19th century where we compete to see who can amputate faster!
Putting on a white coat is like a soldier putting on armor, just like a general putting on a battle robe. Sun Lien's eyes suddenly changed and he walked towards Li Songzhao on the hospital bed.
"Report." Sun Li'en didn't even look at Yuan Pingan, but directly put his hand under Yuan Pingan's nose, "If we want to communicate, we should at least bring out the inspection report and so on, right?"
It seemed that his attitude was arrogant, but Sun Lien actually didn't want to express his dissatisfaction in such a place. He was just observing the status bar above Li Songzhao's head.
"Li Songzhao, male, 21 years old, pulmonary embolism, deep vein thrombosis of lower limbs, stasis ulcer of left leg, gangrene of left toe, act time 210s, anti-fx3-a antibody positive."
The status bar has changed. The most concerning thing about the change is that the state of high blood sugar has disappeared. There are obvious indicators for the diagnosis of diabetes. The fasting blood sugar level is higher than 7.0mmol/l, and the blood sugar level is high two hours after a meal.
The diagnosis can be confirmed when it reaches 11.1mmol/l. The disappearance of the hyperglycemia state indicates that the high blood sugar level in Li Songzhao's body should be just a short-lived and transient hyperglycemia.
The gangrene on his foot was not diabetic foot! Sun Lien understood the key point immediately. If it was not diabetic foot, then the gangrene on his foot was probably a symptom of some undiagnosed disease.
So, what does the act time of 210s mean?
act, activated clotting time whole blood. It is generally used to detect the anticoagulant effect of heparin. The reference value is about 70~130s. After using 8000 units of heparin, Li Songzhao's act time should be at least 400s.
That's right. The 210s data proves that Yuan Pingan's diagnosis is correct and Li Songzhao is indeed not sensitive to heparin.
"This is the report." While thinking about the direction of diagnosis, Yuan Pingan also cooperated and put the previous test report in Sun Lien's hands. "If Dr. Sun needs anything, you can tell me." He smiled complacently.
He smiled and said, "Although our Xiehe Hospital is not a large emergency center, the corresponding examination equipment is relatively complete."
Sun Lien took the examination form, glanced at it, and then continued to ponder the diagnosis.
Anti-f
"Doctor Sun, do you need any other examination methods?" Yuan Pingan kept asking beside Sun Lien like a noisy toad, "We can provide them all."
Sun Lien didn't hear his suggestion at all, he was just thinking about another direction.
How does heparin prevent blood coagulation? Why does Li Songzhao show symptoms of insensitivity to heparin?
Heparin can promote the failure of thrombin, inhibit platelet aggregation, and stimulate vascular endothelial cells to release anticoagulant and fibrinolytic substances. However, Li Songzhao's heparin insensitivity is probably due to a problem in one of these three aspects.
Thrombin failure? No, if there is a problem with the speed of thrombin failure, without heparin intervention, all the blood in Li Songzhao's blood vessels will turn into blood tofu. It is not a problem with platelet aggregation. On his feet
There was a large area of gangrene. If there was a problem with platelet aggregation, he would have died of excessive bleeding when the gangrene first formed.
Excluding these two directions, the cause can only be problems with anticoagulant substances released by vascular endothelial cells or fibrinolytic substances.
Considering that the ATC data is still extended to 210s under the influence of heparin, anticoagulant substances should still be secreted, and fibrinolytic substances... Sun Lien nodded lightly, it's you!
It should be that there is insufficient fibrin in Li Songzhao's blood, or there is a problem with fibrin activation... No, there is a problem with the antibodies that control fibrin! Sun Lien suddenly realized that this is the meaning of a positive anti-f x iii-a antibody! f x iii
Factor is the fibrin stabilizing factor in the blood.
Li Songzhao had some kind of autoimmune disease in his body, which caused the presence of antibodies in the blood that attack factor f