I can see the status bar

Chapter 125 Colleague Experience
Heparin is one of the most important weapons in clinical anticoagulant therapy.Since the discovery of heparin in 1916, this miracle extract has continued to play a major role in the field of human medicine.Especially in cardiac surgery and cardiopulmonary bypass, the use of heparin is extremely common.Unlike drugs such as antibiotics, heparin itself is one of the mucopolysaccharide sulfates that are naturally secreted in the body to control the speed of blood clotting.Therefore, heparin will not fail due to overuse and drug resistance.If you have patients who are not sensitive to heparin, then the situation becomes very difficult.

Especially when a patient suffering from pulmonary embolism develops heparin insensitivity, this situation becomes more troublesome.Coumarin-based anticoagulants such as warfarin are too slow to take effect, and general clinical applications require heparin for anticoagulant "pre-start", and then switch to warfarin to achieve the desired effect.Simply using warfarin is obviously not fast enough in the current situation.

As the apex of Chinese medicine, the doctors of Tongxie Hospital are basically the top figures.Even if it's just a resident doctor in the emergency department who is studying for a doctorate, he can make a judgment immediately after discovering an abnormal situation.Yuan Pingan didn't spend much effort, and decided to ask the Department of Hematology for a consultation - Li Songzhao's situation was indeed a little abnormal.

It only took a few minutes for the hematology department to rush to the emergency room.After receiving the patient's blood coagulation test report and listening to Sun Lien's description, the doctor in the Department of Hematology immediately made a suggestion. "Check his F-XIII blood coagulation factor immediately. Let the comrades in the laboratory work overtime. This one needs to run an ELISA test."

Yuan Ping'an frowned and said, "F-XIII?" He suddenly seemed to understand something, nodded and agreed to the inspection request.After the doctor in the Department of Hematology left, he suddenly asked Sun Lien, "I read from the Liuxiang Garden that Dr. Xiao Sun is good at making diagnoses." He pointed to Li Songzhao who was lying on the bed with a livid face and asked , "Then what kind of disease do you think this patient has?"

Sun Li'en has been working all day today. After being held up for a long time on the plane, he landed and had no place to rest. He went to an Internet cafe overnight and found a seriously ill patient.After tossing about this series of things, my mind has long been numb.He intentionally evaded, "There are too many big names in the association, and I, a small regular trainee, can't afford to talk nonsense here. You can judge, and the most I can do is to visit."

"It seems that Dr. Sun is not willing to deal with an emergency doctor like me who has become a monk halfway through." Yuan Pingan spread all the resentment that he and Liu Pingchuan missed on Sun Li'en, and even Ningyuan Medical College was hated by him. "Or, from your hospital's point of view, our association is of no importance, and even discussing cases has no value?"

Sun Li Engui has been in the emergency room for two months and has seen many kinds of people, but this is the first time he has seen such an aggressive colleague.He frowned and said, "Dr. Yuan, I'm just a regular trainee. I don't have a license to practice medicine. I can't carry out medical activities here."

"It's just a discussion." Yuan Ping'an spread out his hands. Communication between doctors is very common.Even if it looked like he was bullying others, Yuan Ping'an just wanted to severely humiliate Xiao Guipei who was boasted that House was alive.Tell him with practical actions that medical behavior relies on professional knowledge and a large number of case experience, rather than some juggling diagnosis.In his opinion, Sun Li'en is just a lucky guy.The disease diagnosed by Sun Lien is not a particularly rare disease, but the symptoms of the patient are quite unique.

And Li Songzhao's disease is probably the real rare disease.The doctor in the Department of Hematology asked for an ELISA test, which has already prompted the specialist's suspicion.This disease is so rare, if Yuan Ping'an hadn't learned ELISA technology during his postgraduate period and heard 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 FactorⅩⅢ". The number of reported cases worldwide is less than 120, of which 51 cases were reported in Japan.So far in China, only the Capital Tongxie Shanghai Stock Exchange Hospital has confirmed 5 cases.

Just relying on a young man who has been trained for two months and doesn't even have the qualifications to practice medicine, want to make a fuss about diagnosis?Yuan Ping'an almost laughed out loud, I'm afraid even your teacher has never seen this rare disease!How can you diagnose a disease that you have no way of knowing?

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Sun Li'en looked at Li Songzhao lying on the hospital bed, feeling a little anxious.He didn't think that the association could not diagnose Li Songzhao's condition, and Yuan Ping'an's behavior was naturally creating 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 make himself difficult, but did not take any treatment measures.

"If you confirm the diagnosis, you should treat him first." Sun Lien sighed, "The communication can be done after the patient's condition stabilizes."

"His condition is fairly stable. The ELISA test will take about three hours to get the results. Before the results come out, other treatment methods are meaningless." Yuan Pingan spread his hands indifferently, "But if Dr. Sun can make a diagnosis as soon as possible If so, maybe we have a more suitable treatment method!"

Sun Li'en looked at Yuan Ping'an and suddenly felt annoyed. "I'm not a doctor for the sake of showing off!" He looked at Yuan Ping'an and said coldly.Then he put his backpack behind the duty desk, under the banner of "exquisite medical skills, rejuvenation".Hanging his coat on the clothes rack, he picked up a white coat and put it on, "Since Dr. Yuan wants to communicate, let's communicate properly!"

Part of Sun Lien's confidence to challenge his fellow emergency doctors comes from the status bar, and the other part comes from his ideal of the profession of a doctor.Use the patient's condition to compete?It's not a race to amputate faster in the 19th century!

Putting on a white coat is like putting on armor for a soldier, just like putting on a battle robe for a general.Sun Lien's eyes changed suddenly, and he walked towards Li Songzhao who was on the hospital bed.

"Report." Sun Li'en didn't even look at Yuan Ping'an, and directly put his hand under Yuan Ping'an's nose, "If we want to communicate, at the very least, we should bring out the inspection report and the like?"

It seemed arrogant, but Sun Li'en didn't even think about expressing dissatisfaction in this kind of place.He was simply observing the status bar above Li Songzhao's head.

"Li Songzhao, male, 21 years old, pulmonary embolism, deep vein thrombosis of the lower extremities, stasis ulcer on the left leg, gangrene of the left thumb, ACT time 210S, positive anti-FXIII-A antibody."

The status bar has changed.The most interesting thing about the changes is that the state of high blood sugar 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 higher than 11.1mmol/L two hours after a meal.The disappearance of hyperglycemia indicates that the high blood sugar content in Li Songzhao's body should only be transient hyperglycemia.

The gangrene in his foot was not a diabetic foot!Sun Li'en immediately understood the point.If it wasn't a diabetic foot, the gangrene in his foot was probably a symptom of an undiagnosed disease.

So, what does ACT time 210S mean?

ACT, Activated Clotting Time of Whole Blood.It is generally used to detect the anticoagulant effect of heparin.The reference value is about 70~130S.After taking 8000 units of heparin, Li Songzhao's ACT time should be at least 400 seconds. The 210S data proved that Yuan Ping'an's diagnosis was correct, and that Li Songzhao was indeed not sensitive to heparin.

"This is the report." While thinking about the direction of diagnosis, Yuan Ping'an cooperated and put the previous inspection report in Sun Li'en's hands. "If Dr. Sun needs anything, feel free to tell me." He smiled a little complacently, "Although our Tongxie is not a big emergency center, the corresponding examination equipment is quite complete."

Sun Lien took the checklist and glanced at it.Then continue to ponder the content of the diagnosis.

The anti-FX III-A antibody was positive, which Sun Lien had no clue about.And his intuition told him that this should be the key to the whole diagnosis.But this indicator...he hadn't even heard of it once.

"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 Li'en didn't hear his proposal at all, but was thinking about another direction.

How exactly does heparin prevent blood from clotting?Why did Li Songzhao show symptoms of insensitivity to heparin?
Heparin can promote thrombin failure, inhibit platelet aggregation, and stimulate vascular endothelial cells to release anticoagulant and fibrinolytic substances.However, Li Songzhao's insensitivity to heparin may be 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 can't be that there is a problem with platelet aggregation. He has a large gangrene on his foot. If there is a problem with platelet aggregation, he will bleed to death when the gangrene has just formed.

If these two directions are excluded, the cause can only be the anticoagulant substances released by vascular endothelial cells, or there is a problem with fibrinolytic substances.

Considering that the ATC data was 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 the activation of fibrin... No, there is a problem with the antibody that controls fibrin!Sun Lien suddenly realized that this is the meaning of anti-FX III-A antibody positive! FX III factor is the fibrin stabilizing factor in the blood.

Some kind of autoimmune disease appeared in Li Songzhao's body, which led to the appearance of antibodies attacking FX III factor in the blood.Li Songzhao is not sensitive to heparin because of the lack of fibrin stabilizing factor!

　Two updates today, more than 6000 words... Everyone, just treat me as the third update, okay?

　　
　
(End of this chapter)