Blood diseases can cause severe vomiting and back pain. When intravascular hemolysis occurs, free hemoglobin will cause nitric oxide depletion and induce smooth muscle spasm, which manifests as gastrointestinal symptoms, vomiting, and esophageal spasm, which can lead to dysphagia. And bone marrow
Blood vessels may also spasm due to this reason, causing patients to experience back pain. Severe spasm may cause patients to engage in "forced postures". They are driven by pain to maintain a specific posture and cannot be relieved.
"Blood transfusion treatment masked the symptoms of anemia caused by hemolysis, and nine days later, the previously transfused blood cells died, nitric oxide depletion occurred again, and cramps were induced." Yuan Pingan was very confident in his judgment, and in fact Sun Lien also agreed.
Doesn't Yuan Pingan's view coincide with the "acute hemolysis, hemolytic anemia" in the status bar?
"Add a coagulation function test. If the coagulation time becomes shorter, then transfuse two units of suspended red blood cells first." Sun Lien asked Liu Pingchuan for instructions, "I think what Dr. Yuan said makes sense."
Red blood cells contain esterase, which can serve as a coagulant in the coagulation pathway. If the patient has hemolysis, the coagulation time will also change. At this time, doctors must first consider whether to replenish suspended red blood cells to correct the anemia.
, or inject anticoagulants to prevent the formation of blood clots.
Starting from Yuan Pingan's diagnosis, of course, we should first replenish suspended red blood cells. After the increase in red blood cells, the nitric oxide in the body can be quickly replenished. This is also a very effective measure for relieving Zhan Hao's smooth muscle spasm.
"The doctors at the Second Hospital are not fools." Liu Pingchuan shook his head gently, "Xiao Yuan's idea is very good, but it is too easy to confirm this kind of problem. If the Second Hospital still hasn't figured out what he has,
Disease, then it shouldn’t be so straightforward.”
Although the Second Central Hospital is not as good as the First Central Hospital and the Affiliated Hospital of Ningyuan Medical College in terms of strength and reputation, it is still an excellent hospital that ranks among the top ten in the province in terms of comprehensive capabilities. The reputation and strength of the hospital are not dependent on
The result of repeated advertising bombardment. This is the recognition that a hospital, from top to bottom, all doctors, nurses, auxiliary departments, and even other staff, have worked hard for more than ten years to get. It is the recognition and trophy that the doctors get for their hard work against the disease.
.
Although the doctors at the Fourth Central Hospital always look down on the Second Hospital, especially the way they cry at the top of their lungs and fight for food. But when it comes down to it, these colleagues are indeed very talented.
What's more, the Fourth Central Hospital has always wanted to rub the Second Hospital on the ground. If the quality of the Second Hospital is a mess, wouldn't it be blackmailing itself from another angle?
Liu Pingchuan's attitude was relatively calm. Doctors who were born in the Tongxie Association looked like this to everyone anyway. Therefore, Vice President Liu directly pointed out that if the logical problem in Yuan Pingan's diagnosis was really that simple, then the two
How could the hospital not diagnose it?
Sun Lien's view is different. Zhan Hao must have hemolytic anemia. The status bar has directly told him this. But the question is, what is the cause of hemolysis. After all, hemolytic anemia and central nervous demyelination disease
Same, it's just a description of symptoms. To cure Zhan Hao, the key still lies in finding the cause.
"New examination results." Xiao Guo became the busiest errand boy in the entire emergency room. He ran back to the conference room with the results he just printed out and handed the examination report to Sun Lien.
"Alt (alanine aminotransferase) 196 u/l, tb (total bilirubin) 64 μmol/l." Sun Lien quickly saw two abnormal values, "There is no problem with the diagnosis of acute liver injury."
"Another hospital used GSH (reduced glutathione) in the treatment, which is also a symptomatic treatment." Dr. Pascal rubbed his chin. He squinted his eyes and said, "There is nothing wrong with their treatment method."
Liu Pingchuan thought for a while, "Then let's continue the treatment." He leaned back and said thoughtfully, "If the second hospital has done everything right, then why did the patient suddenly become ill after being transferred to us?"
"The most reasonable explanation is that the Second Hospital did something wrong, or they didn't do enough." Yuan Pingan seemed to have no problem with being criticized for his diagnosis. However, he still had some disdain for the Second Hospital.
, "If they do everything well, then this patient must not just come to our fourth hospital, right?"
"I'll go to the laboratory to check the situation." Sun Lien pondered for a while and felt that the significance of being here was not very great. The content discussed by this group of top students was almost beyond his understanding. The blood routine required a blood replenishment.
The relationship between the smears has not yet come out, so he plans to go to the laboratory to see if he can get first-hand data. He also stops by Zhan Hao's bed to see if there are any new changes in the status bar above his head.
However, the reality was disappointing. There was no update in the status bar. But Sun Lien heard some bad news from Shi Yan.
"This sample has obvious hemolysis, and you can see a lot of reticulocytes and basophilic stippling red blood cells under the microscope." Shi Yan scratched the back of his head with a pen, looking a little absent-minded, "I suggest you be a mechanical
Supplement the brittleness experiment."
"How long will this take?" Sun Lien asked, "Do you think it is necessary?"
"According to the requirements, this experiment takes at least 48 hours. The appearance of reticulocytes and basophilic stippling red blood cells is a sign of anemia. The increase in reticulocytes means that the patient may have hypertrophic anemia or hemolytic anemia. From
Judging from the samples, it should definitely be hemolytic anemia." Shi Yan explained, "But the possibility of increased basophilic stippling red blood cells is more likely, such as heavy metal poisoning, organic compound poisoning, hemolytic anemia, etc.
Pernicious anemia... Anyway, there are many reasons for this. If you want to figure out the direction, you must first determine the cause of hemolysis."
"I am also worried about this matter." Sun Lien spread his hands helplessly, "This patient is Zhan Jun's brother. When I went to his shop yesterday, he was still asking me about my recovery..."
"Recovery?" Shi Yan frowned, "Why is it related to recovery again? Isn't this hemolytic anemia?"
"There are also symptoms of central nervous system demyelination." Sun Lien briefly explained the situation to Shi Yan. "The Second Hospital initially thought that the acute abdomen was caused by acute hepatitis, and they felt that the situation was under control.
.I guess you will focus on the weakening of lower limb muscles later on, right?"
Shi Yan shook his head and said, "Then when Zhan Jun sends his brother to our fourth hospital, you will focus all your energy on hemolysis?"
Sun Lien was about to retort, but suddenly he felt that something was not quite right. This was a very subtle feeling, so subtle that he needed to turn his head and think without saying a word.
"It's not just hemolysis..." Shi Yan was separated by a layer of glass and couldn't see Sun Lien's expression and movements clearly. He thought that this guy was criticized by him to the point where he had nothing to say, so he fell silent. Unexpectedly, he just
After saying five words, Sun Lien said, "Shut up!"
Shi Yan touched his nose and fell silent. He could see that Sun Lien seemed to be thinking hard about something. When they lived together in the dormitory before, if this happened to Sun Lien, it was because he was dealing with some difficult problems.
Fight, and you may have caught clues to solve the problem. It is best not to disturb him at this time.
"No... I still can't figure it out." After trying hard for a while, Sun Lien shook his head and sat down. He seemed to have grasped a key point just now, but when he really wanted to go back and pull out the key point, he couldn't even think of what the key point was.
Not coming out. Sun Lien grabbed his hair in frustration, and even wanted to blame Shi Yan for interrupting at an inappropriate time.
Shi Yan walked out of the inspection window and brought out a round lift chair with wheels. "It's normal if you don't understand it. You are just a young professional, and you are not the reincarnation of Conan. You can figure it out in a flash of inspiration."
Details of everything." Although the words are mocking, the core content is comfort.
"Let's do the mechanical brittleness experiment." Sun Lien shook his head and stood up, "Under the current circumstances, it would be good to have one more reminder."
"Actually, you should first think about the cause of this patient's hemolysis." Shi Yan stood up and walked back towards the door of the laboratory department, "There are generally only a few causes of hemolysis, mechanical hemolysis, osmotic pressure
Change hemolysis, microbial hemolysis, and toxic hemolysis." He slowly wandered into the laboratory, "Only when we understand the cause of hemolysis can we diagnose what disease he has, right?"
Twelve hours have passed. Zhan Jun is busy opening a shop and taking care of his son, so he is not in the hospital. Except for Dr. Pascal and Liu Pingchuan, no one in the entire treatment team has left the hospital.
Even lunch and dinner are taken out.
"This is not an option." Xu Yourong stood up and stretched. She looked at the diagnosis information on the whiteboard where items were drawn one by one and then crossed out one by one. "I'm going to go out and breathe some fresh air."
Yuan Pingan took the opportunity to announce that he was going to the toilet, but Zhou Ce simply said, "I'll go back and take a shower and change clothes."
The members of the treatment team left one after another, leaving Sun Lien alone and stubbornly standing in front of the whiteboard in silence. He also wanted to just throw away his hands and ignore it for the time being, but as the "head" of the treatment team, everyone else
You can leave first, but Sun Lien himself absolutely cannot.
If even he gives up, who can treat Zhan Hao?
Hu Jia quietly approached from behind and hugged Sun Lien. She had been standing at the door of the small conference room for almost half an hour. When Xu Yourong went out, she quietly walked in.
Sun Lien was startled when he was suddenly hugged. He turned around and breathed a sigh of relief when he found that it was his girlfriend. He raised his right hand smoothly, touched Hu Jia's head and rubbed it, "Why are you here?"
La?"
"Come to see my Director Sun." Hu Jia saw that there was no one else in the small conference room, so he generously came up and kissed him. Then he looked at the whiteboard with curiosity and asked, "Is this patient in trouble?"
"You heard what Zhan Jun said yesterday." Sun Lien said with a wry smile, "It took nine days at the Second Hospital, but they didn't even know what disease he had. If we could figure it out right away, wouldn't that be abnormal?
"
Hu Jia glanced at the whiteboard, which listed several possible causes of hemolysis based on their guesses. Then basically every possible cause was crossed out with a horizontal line.
"Thank you." Hu Jia nuzzled Sun Li'en and then asked, "Are you going to work overtime tonight?" After saying that, she took out a small stew pot from behind. "This is the preserved egg dumpling I made at noon.
Meat porridge for you as a midnight snack."
"I happen to be hungry." Sun Lien answered shamelessly. In fact, his mind was occupied with the diagnosis. Not to mention wanting to eat, he couldn't even tell whether he was hungry or not.
"Originally, I braised some meat and wanted to bring it to you. But the coating on the inside of the insulated box I used came off. I was worried that it might not be good for you to eat..." Hu Jia said a little embarrassed.
I had braised a lot of meat and vegetables such as pig's trotters, but I didn't bring them over. While explaining, Hu Jia secretly made up his mind that he would go to the supermarket to buy a new set of insulated boxes and the like later.
Sun Lien was stunned for a moment, then again. The expression on his face changed from a smile to a frown.
"What's wrong?" Hu Jia couldn't help but worry when she saw her boyfriend changing his face. Unexpectedly, Sun Lien picked up Hu Jia and laughed while hugging him, "Dear, you