When doctors have a simulated operating room

The patient was diagnosed with leukemia.

All the medical instructions and records were based on the treatment of bleeding, so what was the problem?

Zhang Yi frowned, and he also felt a little strange.

Then, Zhang Yi looked through all the examination sheets of this patient, including B-ultrasound, blood routine, CT and angiography results.

After a round of inspection, there was nothing abnormal.

This means that this patient was only diagnosed with hemorrhoids when he came to the hospital.

Although he had bloody stools for more than a month, he did not even have anemia.

It was only after he came to the hospital to have his hemorrhoids removed that he had bleeding and underwent three operations that he developed anemia, and his hemoglobin dropped to 98g/L.

Before, his hemoglobin had always been above 110.

Damn it.

What's wrong with this medical record?

Needless to say, it really aroused Zhang Yi's curiosity.

Zhang Yi simply sat on the chair and read the medical record again and again.

While reading, Zhang Yi combined the patient's physical condition in his mind.

Except for a few bleeding spots in the intestine, the patient had no other injuries.

There was no heart disease or tumor.

"The white blood cell and eosinophils in the blood routine are not high, and the four coagulation tests were normal after three times.

There are no infectious diseases such as AIDS, syphilis, and hepatitis B.

It's strange, this guy is really strange..."

Zhang Yi said to himself.

Suddenly, Zhang Yi focused his eyes on the four coagulation items.

The knowledge points in his mind also rolled quickly, trying to find the most correct point!

The four coagulation items are a must-check item for every patient admitted to the hospital.

Including prothrombin time, thrombin time, fibrinogen quantitative and activated partial thromboplastin time.

These indicators are a combination of the patient's coagulation factors.

Generally speaking, as long as the test results are normal, it means that the person has no coagulation disorder.

He can go to the operating room, and there will be no major bleeding during the operation.

But this patient bled inexplicably after the operation? ?

Zhang Yi looked at the records and found that he had three urgent coagulation tests on the day of admission, the fourth day, and this morning.

There should be no problem with the test results of Union Hospital, and they were the same three times.

And the doctor's order also used anticoagulants, but these anticoagulants were useless for this patient...

What's going on? ?

Zhang Yi frowned and thought and watched again and again...

Suddenly!

Zhang Yi's eyes lit up!

That's right!

There are also genes!

This patient didn't check the coagulation gene! !

It's true that all patients must check the four coagulation tests when they are admitted to the hospital, but this is for the general public!

Ordinary people can basically get their coagulation function and whether they have coagulation disorders by checking the four coagulation tests.

But this is only for ordinary patients!

There is also an extremely rare possibility, that is, this patient may have a disease that cannot be detected by the four coagulation tests!

It is called hemophilia!

It is an X-linked recessive hereditary bleeding!

It is caused by the lack of the coagulation factor VII gene (hemophilia A) or the coagulation factor IX (hemophilia B) gene in the patient's body.

This disease can only be detected by genetic testing!

Lack of VII is called hemophilia A, and lack of IX is called hemophilia B.

This disease is not easy to detect because it is rare. The routine coagulation four items for admission to the hospital are most of the census.

As long as this result is fine, it means that the patient has no coagulation disorder.

But this patient is a rare hemophilia patient.

That's why it took so long to treat and so many anticoagulants were infused, but it didn't work.

Because the medicine was not infused to the point.

Hemophilia A lacks the VII gene. If this patient wants to stop bleeding, he can only infuse blood containing more VII genes to treat bleeding.

Hemophilia B lacks the IX gene, and the treatment is the same as that of hemophilia A.

For this kind of patients, the bleeding can only be stopped by transfusing what is lacking.

Other cases are definitely untreatable.

Thinking of this, Zhang Yi suddenly understood.

This must be the reason!

His speculation should not be false!

Just at this time, a curse came from outside the office.

Zhang Yi could tell by the sound.

It was Wang Bin's father who started cursing.

"Bleeding again? Is your hospital any good? My son has had three operations here, and his health is getting worse, right?!"

Xiao Long lowered his head slightly, and the curses from the family members really made him feel uncomfortable.

But as a doctor at this moment, he could only bear it:

"Sorry, I have informed the director, he will come to the hospital soon."

"Hehe? Director? What director! My son was operated on by your director! Isn't it useless?!

I tell you! If anything happens to my son, I will never let Kang Yanming go!

It's him! Damn it, the operation hurt my son like this!"

"Sorry, we don't want this result to happen. We are also trying our best to treat him. I hope you understand."

"Understand? I understand you! I understand you, who will understand me?!"

The family member's face turned red and his neck became thick. The patients and family members watching around felt his anger.

At this time, Zhang Yi came over. He also understood the family's feelings, so he spoke in a gentle tone:

"Family, please don't worry. I think the biggest problem of your son may not be hemorrhoids, but a rare genetic disease."

The family rolled their eyes at Zhang Yi and said unhappily:

"Who are you! The director of the emergency department can't cure it, how can you cure it?!"

Zhang Yi was not angry, and continued to ask:

"Did your son often get bruises when he bumped into something, and his gums would often bleed when he brushed his teeth?"

The family member looked up and glanced at Zhang Yi: "No! My son has been healthy since he was a child, and this has never happened!"

"Huh?" Zhang Yi was slightly stunned.

It shouldn't be. If it is a coagulation gene defect, there will be all kinds of bleeding possibilities since birth.

Bumps and bleeding gums are just minor problems.

It is very likely that the bleeding will be unstoppable if it is a little bit larger, and the person will die.

But this person...how could this person not have this situation?

Could it be that Zhang Yi made a mistake in judgment this time?

On the side, Xiao Long gently pulled the corner of Zhang Yi's clothes and whispered:

"Our director has already asked about this question, and the family has ruled out the possibility of hemophilia inherited from their ancestors."

When listening to Zhang Yi's question, Xiao Long already knew what Zhang Yi was doubting.

Before leaving get off work today, Kang Yanming also suspected whether this patient had hemophilia.

He also specifically asked the family, and the family said that no one in the family had ever had this disease.

The whole family is very healthy.

It was also the first time for his son to go to the hospital for such an operation.

It was also the first time that he had continuous bleeding.

This answer made Kang Yanming confused.

The puzzled expression was exactly the same as Zhang Yi's current one.

Could it be that Zhang Yi really made a wrong diagnosis?

This person is not hemophiliac?

Then what is the situation?

The family members cursed outside for a long time.

When Zhang Yi and Xiao Long entered the emergency room, they saw that there was not much blood in Wang Bin's drainage bag, still more than 20 milliliters.

Fortunately, the amount of bleeding is not large.

Zhang Yi looked at the intestinal location and the amount of bleeding inside was not much.

But the problem still needs to be solved as soon as possible.

There may be sudden heavy bleeding.

Looking at the patient on the bed, Zhang Yi said to Xiao Long:

"Did Director Kang ask you to do a genetic test for blood coagulation?"