The speed of doing gbm testing depends on the examination method. To be honest, there are really not many hospitals that can do gbm antibody testing, and even fewer hospitals can do the more advanced colloidal gold method. The Fourth Central Hospital can only do it Antibodies have been detected through immunofluorescence technology. It takes half a day from the time the specimen is delivered to the time the test results come out.
The test results of kidney biopsy are much faster. It mainly depends on how long it takes for the pathologists to recognize what the specimen is.
Doctors in the Department of Pathology have always regarded themselves as "doctors among doctors." Regardless of whether they are internal medicine or surgery, the diagnosis of many diseases relies on their observation and judgment under the microscope. If someone can judge the condition of a hair by looking at it, Which animal it belongs to, then this person must be a pathologist.
This time, this group of doctors who like to look for evidence under a microscope found a very disappointing result. "50% of the samples were crescent-shaped, and linear deposits along the glomerular capillary loops were visible under the electron microscope." Immunoglobulin g.”
Crescents are crescent-shaped bodies formed around the capillary plexus due to significant proliferation of epithelial cells in the wall of the glomerular sac. They accumulate into layers and form around the capillary plexus. It generally means that the kidneys have been severely damaged. And loop-like immune deposits are Globulin g confirmed Sun Lien's guess that this was a typical case of pulmonary hemorrhage-nephritis syndrome.
Pulmonary hemorrhage-nephritis syndrome itself is extremely difficult to diagnose for the first time. Basically all pulmonary hemorrhage-nephritis syndrome will be misdiagnosed as other diseases at the first diagnosis. Doctors will start to suspect that the patient will not improve after two or three days of symptomatic treatment after admission. to pulmonary hemorrhage-nephritis syndrome.
It’s not because this disease is difficult to diagnose. A kidney biopsy can basically diagnose about 80% of pulmonary hemorrhage-nephritis syndrome. Mainly because the disease itself has a low incidence rate, and the symptoms displayed by patients are too similar. Diseases such as pulmonary tuberculosis, idiopathic pulmonary hemosiderinosis, polyarteritis nodosa, and systemic lupus erythematosus. Moreover, the disease progresses quickly and the prognosis is poor. Many patients may even die without being diagnosed. The cause of the disease. Due to the limitations of the domestic environment, most family members of patients will not choose autopsy to clarify the cause of the disease. Therefore, it is difficult to explain the true incidence rate.
Because the condition is too featureless and the process is very vicious, many times, doctors have no time to consider other possibilities and have to face the fact that the patient has died. In fact, Lian Zhou Jun, Xu Yourong, Zhou Ce, and Yuan Pingan , even Dr. Pascal almost fell into this trap. Before the results came out, they still insisted that Wang Lin's main problem was infection.
Sun Lien was happy for just two minutes, and then suddenly realized a bigger problem.
Wang Lin's status column clearly stated that he had a Staphylococcus aureus infection.
For pulmonary hemorrhage-nephritis syndrome, patients need to receive high-dose glucocorticoid shock, combined with immunosuppressants and plasma exchange, to effectively relieve symptoms and prolong life. However, this treatment measure completely adds fuel to the fire for infection. Staphylococcus aureus infection can cause very serious diseases, ranging from lung abscess, sepsis to systemic multiple organ failure. If antibiotics are not used to suppress the bacterial infection immediately, Wang Lin's death will only be a matter of time.
However, for the treatment of infection, it means that no immunosuppressive actions can be performed. Otherwise, the antibiotics will not only fail to have the desired effect, but may also continue to deepen the original kidney damage due to nephrotoxicity or hepatotoxicity.
Faced with another dilemma, Sun Lien grabbed his hair in pain. The most troublesome thing is that the culture results of the lung lavage fluid have not yet come out. Now he is the only one who knows that Wang Lin also has Staphylococcus aureus infection.
Treatment cannot be based solely on this result, but must wait until the culture of the lavage fluid is obtained. Sun Lien made a decision.
"Staphylococcus aureus infection?" In the laboratory department, Zhao Weiguo put down the newspaper in his hand and looked over his glasses. The laboratory doctor holding the laboratory report at the door nodded, "This is the examination request ordered by Dr. Sun Lien of the emergency department.
"
Upon hearing the words Sun Lien, Zhao Weiguo frowned. He took off his reading glasses, pondered for a moment and then said, "Print a copy of all the examination results and information about this patient for me.
.”
The laboratory doctor was stunned for a moment, then nodded. When he turned around and was about to walk out of Zhao Weiguo's office, Zhao Weiguo spoke again behind him. "The test results will be given to him in two hours."
About 20 minutes later, all of Wang Lin's test results appeared on Zhao Weiguo's desk. He picked up the report and read it briefly, and then suddenly stopped at the results of the renal biopsy. The expression on his face was very complicated.
, there is both shock, confusion and a hint of jealousy.
"Pulmonary hemorrhage-nephritis syndrome was diagnosed at the first diagnosis, and Staphylococcus aureus infection was also detected by culture?" He murmured to himself in a low voice, then smiled and shook his head, "I don't know whether he was lucky or not.
Bad luck." Zhao Weiguo's plan is very simple. After the doctor confirms the type of patient's disease, he will directly decide on treatment. For pulmonary hemorrhage-nephritis syndrome, the most mainstream and effective treatment plan is immunosuppression and high-dose hormone shock.
Combined blood replacement. But as long as Sun Lien dares to use these treatments, the patient will definitely die. Without immune system control, the Staphylococcus aureus that has infected Wang Lin's lungs will kill him in the shortest possible time.
The laboratory department has obviously been asked to conduct bacterial culture, but before the results are available, it is switched to immunosuppressive treatment. This is definitely a medical malpractice. The doctor did not avoid the foreseen risks. Based on this alone, as long as the patient dies, then
By instigating his family members to sue, Zhao Weiguo could throw Sun Lien into the eighteenth level of hell without even getting his hands dirty, and he would never be able to stand up again.
If it had been half a month ago, he would have done this. Just because Sun Lien instigated Liu Pingchuan to conflict with him, Zhao Weiguo was determined to kill Sun Lien. The laboratory test is his independent kingdom, his own three-acre
It is absolutely unacceptable for someone to act wildly in the branch, even if it is the deputy dean who comes to act wildly. Liu Pingchuan cannot be dealt with. If he does not suppress Sun Lien, how can he continue to maintain his position in the inspection department?
But this half month is different. Kobayashi Yutaka of Takeda Pharmaceutical relied on several connections to hire Zhao Weiguo’s son and daughter-in-law into the company. They basically don’t have to do anything every month, and the two of them can get about 6 million yen.
Of course, such a generous remuneration was not given in vain. Xiao Linfeng directly explained that Zhao Weiguo was required to provide all of Sun Lien's examination and diagnosis records, and he must provide "the most exciting ones."
Xiao Linfeng probably planned to praise Sun Lien. He promoted this young and promising young doctor to a high position, and then cheered for Takeda. This was Zhao Weiguo's final judgment on Xiao Linfeng's series of actions. He also had to admit that Xiao Linfeng's vision was
It's really good. In the past half month, Sun Lien has diagnosed many difficult patients in succession. This time, it's even more remarkable. He even made the first diagnosis of pulmonary hemorrhage-nephritis syndrome.
Zhao Weiguo was actually very conflicted in his heart. He really wanted to punish Sun Lien, and he felt happy. But the job that his son and daughter-in-law had just received would definitely go to waste. But if he followed Xiao Linfeng's baton around, he would wait until Sun Lien really stood firm.
Who knows if he will turn around and cause trouble for himself?
After pondering for a while, Zhao Weiguo sighed and decided to go to Sun Lien himself. In case he started immunosuppressive treatment, he could use this report to sell him a favor of "concealing the report". If he hadn't already
, then just use this report to show the importance you attach to the emergency department. You can have both sides, advance and retreat. This is the plan of Zhao Weiguo, a veteran.
"The blood routine report an hour ago made it very clear. Hb (hemoglobin) is 55g/l. We have already transfused eight units of suspended red blood cells to him. If he delays it any longer, he will be dead!" Yuan Ping'an said at the meeting
The person in the room rushed to Sun Lien and said, "The test results have confirmed your suspicion. It is indeed pulmonary hemorrhage-nephritis syndrome. Why not treat it immediately?"
"The patient's WBC (white blood cell) count is also increasing, reaching 11.4x10^9/l." Sun Lien is still trying to convince Yuan Pingan, "He may have other problems. At present, the greatest possibility
It’s an infection.”
Dr. Pascal also supports immediate immunosuppressive treatment. “Patients with autoimmune diseases may have anga (anti-neutrophil antibodies) in their blood, and although it is very uncommon, when suspended red blood cells are continuously transfused,
, may also cause anga to be generated in the patient's body. In other words, the level of white blood cells in his body may be higher than the data we have seen. Before the results of the lung lavage fluid test are available, I also recommend postponing immunosuppressive treatment.
It's worth the wait."
Zhou Jun sat on the stool and sighed. He said seriously to Sun Lien, "If you are free recently, you should really find a temple and worship. The incidence rate is one in a million, and you will encounter it.
With such good luck, why don’t I see you buying lottery tickets?”
"The chance of winning the lottery is one in 2140. From a numerical point of view, it is at least 21 times harder than this patient." Xu Yourong was reading the paper. After hearing Zhou Jun's words, she couldn't help but feel embarrassed.
He changed his tone and added, "When Dr. Sun encounters this kind of patient another 20 times, he should buy lottery tickets."
Sun Li'en was meowing at the insults from these big guys, and he didn't dare to say a single unnecessary word. Anyway, as long as you don't give Wang Lin glucocorticoids, even if you continue to fight for two hours, Sun Li'en will recognize Dr. Guipei.
The value of existence is to pretend to be a grandson and be criticized by the superior doctor. While performing normal duties, you can save a life, which is quite cost-effective.
The door of the conference room was suddenly pushed open, and a middle-aged man who looked energetic burst in from the door. He looked around nervously, opened his mouth and asked, "Has Wang Lin's treatment started?"