Performing a biopsy on a patient with symptoms of pulmonary hemorrhage is an extremely high-risk medical decision. Especially when the patient is suspected to have a tendency to spontaneously bleed, the risk is that the biopsy will cause damage to the organ, which is harmful to the body.
Patients who do not have a tendency to spontaneously bleed need to stay in bed strictly and tie elastic bands around the body to stop bleeding. Performing a biopsy on a patient who is bleeding may lead to more serious bleeding.
dead person's.
But it is imperative to puncture Wang Lin's lungs. If the cause of his disease cannot be diagnosed, it is obvious that he will not be able to survive for long just by supplementing suspended red blood cells. Even if he can survive with suspended red blood cells, he will wait until his kidneys completely shut down.
, Wang Lin still had to die as a patient with severe anemia due to unknown reasons, and there was no chance of even relying on dialysis to survive.
"Of course there are risks." Sun Lien said to Xu Yourong, who was about to stop him, "but if we don't do a biopsy, we won't even know what his problem is. His coagulation time is normal, which means that the bleeding is not spontaneous.
There are of course risks in performing a biopsy on a bleeding lung, but this risk is still acceptable compared to the consequences of doing nothing."
Xu Yourong frowned and asked, "Maybe other means can be used? Such as PCR or MNGS..."
Sun Lien sighed, "There's not enough time. And we don't have relatively few suspects. A PCR test takes six or seven hours, and MNGS takes even longer... and patients may not be able to accept examination items that cost tens of thousands of yuan.
Especially this kind of project may not be able to detect the problem.”
"You mean...it's not necessarily infection?" Yuan Pingan asked his question, "I thought you had identified the root cause of the problem as infection."
"The patient's lungs are definitely infected. However, it is still unclear whether there is a direct connection between the infection and his proteinuria, and whether the infection is related to severe anemia." Sun Lien rubbed his forehead in pain. "The biopsy is ours
The only way to determine whether there is a connection between the three."
"Let's do a lung puncture biopsy first." Zhou Ce put forward his own suggestion after thinking about it. "Continue to monitor the blood routine and at least rule out renal anemia. The kidney puncture damage is too big, and it may not be possible to puncture all the blood in one go.
The damaged area. Lung biopsy, we can at least start with the location of the lesion first."
"Speaking of which, have you met the patient's family?" Sun Lien and Dr. Pascal went out together. He planned to go out to eat something, while Dr. Pascal had to go to the outpatient clinic today. The two happened to be on the same road.
While walking on the road, Dr. Pascal suddenly said to Sun Lien, "I heard that this patient is a patient who has the capacity to be admitted first?"
Sun Lien nodded, "Dr. Xu didn't agree with Director Zhou's diagnosis of tuberculosis at first, and then he asked me to take a look."
"So, you haven't met the patient's family yet?" Dr. Pascal touched the top of his head, "It would be better to go and meet him after you finish breakfast. At least explain to the patient face to face that you are
He's the attending doctor."
For the attending doctor, it is a kind of etiquette to meet the patient and the patient's family in person and identify themselves to each other, and it is also a very important interactive link. Many experienced doctors have emphasized that only after meeting the patient and the patient's family
After meeting the family members, a patient can transform from a mere "case" into a living person. And this kind of meeting is also a kind of respect for the other party. You are my doctor, and we need you to treat the disease.
Such a meeting can also make the patient's family feel a little more mentally stable.
"I'll go now." Dr. Pascal didn't make many suggestions to Sun Lien, but every time he suggested it was important. After Sun Lien pondered for a moment, he made a decision directly. He wasn't very hungry anyway.
"Wang Lin's family, are Wang Lin's family here?" the radio sounded in the emergency room.
"Yes, yes." A pretty young girl jumped up from her seat in a hurry, carrying a bag, and ran all the way to the door of the emergency room.
"Hello." Sun Lien nodded towards the little girl, "I am Wang Lin's attending doctor."
"Doctor, how is my dad?" The little girl didn't have time to be polite to Sun Lien. She grabbed the bag on her shoulder and seemed to be trying hard to keep it from falling. "Is he...is he okay?"
Sun Lien stood at the door of the emergency room. He stepped aside slightly and said, "It's not appropriate to discuss the patient's condition in public. Come with me." He led the way and brought Wang Lin's daughter into the conference room.
.
"Please sit down." Sun Lien sat down by himself, "Don't be too anxious yet. Your father's condition is not very good, but it has not reached the most serious level yet."
The little girl is not very old. The status bar shows that she is 21 years old and her name is Wang Xinrui.
And I have Hashimoto's thyroiditis.
Sun Lien looked at Wang Xinrui with some confusion, then tried hard to look away from her head, and began to ask about Wang Lin's illness.
"Has he had a fever and cough for a month?" Sun Lien looked at the case and prepared to check the case record again.
"Yes." Wang Xinrui nodded. Although the questions asked by this young doctor were similar to those of the previous doctor, he gave people the feeling that he was "verifying some kind of guess". This sense of having no reason,
But it made Wang Xinrui feel some hope in her heart.
"During this period, did he have any symptoms of blood in the stool or vomiting blood?" Sun Lien planned to solve Wang Lin's rapid anemia first. If the patient suffers from certain diseases that can cause hidden internal bleeding, that may explain why the eight
Within hours, his hemoglobin would have dropped so much.
"No..." Wang Xinrui shook her head. Her mother died young and she has been living with her father. "Since my mother passed away, my father has quit smoking and drinking. He lives a very regular life."
Sun Lien frowned and asked tentatively, "Did your mother die of any disease?"
"No, it was a car accident." Wang Xinrui was a little surprised by Sun Lien's question. It didn't sound directly related to Wang Lin's illness.
"Do any of your father's relatives have any special diseases? For example, what substances are particularly susceptible to allergies, or have lupus erythematosus?" Sun Lien quietly squeezed the pen in his hand. He vaguely felt that the answer to this question was very important.
important.
"Yes." Wang Xinrui nodded, "I have Hashimoto's thyroiditis, and my aunt and second aunt also have it. My aunt said a few days ago that she was diagnosed with something... Sjögren's disease?"
"Sjögren's syndrome?" Sun Lien put down the pen in his hand. He had a very bold guess.
Hashimoto's thyroiditis is an autoimmune disease, while secondary Sjögren's syndrome is the result of a highly developed systemic autoimmune disease. Wang Lin's two sisters both have autoimmune diseases, and he
His daughter also has it. Taking into account the common familial nature of autoimmune diseases, Sun Lien believes that Wang Lin may also have some kind of autoimmune disease. It is this disease that caused his lung bleeding and suspected kidney failure.
Glomerulonephritis.
Sun Lien currently has a suspected target of "pulmonary hemorrhage-nephritis syndrome".
Judging from the name alone, it is also the most suspect.
The specific cause of this disease, called good-pasture syndrome, is still uncertain. However, it is generally believed that the patient first suffered lung damage, which then caused antigenic changes in the patient's alveolar basement membrane, thus producing anti-basement membrane antibodies.
This anti-basement membrane antibody also acts on the glomerular basement membrane, so patients will experience symptoms of pulmonary hemorrhage and nephritis at the same time.
The symptoms were correct, and the cause of the disease might be Staphylococcus aureus infection. Sun Lien took out his mobile phone and started to make a call, completely ignoring Wang Xinrui, who was sitting opposite, looking confused, not knowing what was going on.
"Dr. Pascal, please come to the emergency room right away." Sun Lien said nothing and took Pascal back. Pulmonary hemorrhage-nephritis syndrome is still an autoimmune disease in nature. Please call the rheumatology and immunology department.
Dr. Pascal came to see that he was a professional. After the phone call, Sun Lien called Xu Yourong again and immediately stopped the lung biopsy. "The patient may have pulmonary hemorrhage-nephritis syndrome. Do not do a lung biopsy."
I'll do a blood test for gbm (anti-glomerular basement membrane antibodies), and then do a kidney biopsy."
GBM (anti-glomerular basement membrane antibodies) is the decisive evidence to diagnose this syndrome, and renal biopsy is to determine how severe damage this syndrome has caused to Wang Lin's kidneys.
The syndrome itself is extremely difficult to diagnose, and the damage to the kidneys is very serious. If the results of the renal puncture are OK, the condition can be controlled with blood replacement and immune system suppression treatment. Some very lucky patients can even self-control.
But for other people who are not so lucky, the result they need to face may be to remove both kidneys and undergo dialysis for more than two years. Only after confirming that GBM (glomerular basement membrane antibodies) has disappeared can they prepare for kidney transplantation.
transplant.
After ending a series of phone calls, Sun Lien explained his actions to Wang Xinrui and emphasized, "We are still not sure at what stage your father's condition has reached. Only through blood tests for specific antibodies can we confirm the diagnosis, and only if
Through puncture biopsy, we can judge what treatment will be better for him later."
"Is this disease... very serious?" Wang Xinrui found it difficult to accept Sun Lien's statement about "how far the disease has reached." "I also have Hashimoto's. Can't I control the antibodies by taking medicine?"
"Antibodies can be controlled to no longer cause damage to the body, but the original damage still exists." Sun Lien explained, "It's like driving a lot of nails into a piece of wood. Taking medicine to control the antibodies is like stopping or even pulling out the nails.
It will fall off, but there will still be a lot of holes in the board. If the holes are not too many and not too deep, maybe the board can continue to be used. But if they are all nailed, then the board will be damaged.
It can no longer function normally. If it is not replaced, it will only bring more threats to the entire bucket."
Wang Xinrui wondered for a while, then sighed, "I'll listen to you."