Shocking. This was the first impression. On the bed was a boy of seven or eight years old, with dense red rashes on his exposed face and neck. It would be more appropriate to say that the rash had eyes and noses. Lifting the quilt. The boy had bruises of all sizes all over his body, which looked very creepy. "Have you done a blood routine?" Xu Qiu asked. The boy's physical signs looked like spontaneous skin and mucous membrane bleeding. Bruise may be intradermal or subcutaneous bleeding points. However - the density of this bleeding is a bit too high.
It's like a map of human skin. In this case, the first thing to be alert to is thrombocytopenia! Platelets are a component of blood, and their main function is to stop bleeding. The normal platelet count is between 100 and 300 units. Once the platelet count is less than 10, there is a risk of life. Platelet suspension must be transfused immediately to prevent intracranial hemorrhage. "It's done, and we're still waiting for the results... We came from the community hospital..." the boy's mother said in a panic. Xu Qiu: "Where are the medical records and examination reports?" The boy's mother said: "The community said that there is no need to transfer to another hospital, but my baby is in such a state, we are afraid! So we didn't complete the discharge procedures and sent him here directly!" Xu Qiu understood. No wonder there are no medical records and examination reports, it turns out that he slipped out. He glanced at the boy. Such severe spontaneous bleeding, estimated that the blood routine is not optimistic, so he asked the nurse to prepare platelet suspension and various fluid replacement measures first. Here, Xu Qiu asked about the condition. "How long have these symptoms lasted?" "..." "Are you weak, have a fever, vomit or have diarrhea?" "..." "Have you taken any medicine?"
... After the consultation, Xu Qiu gave the boy a detailed physical examination. The liver and spleen were not enlarged by palpation. Auscultation was normal. Xu Qiu frowned slightly, and he checked the boy's mouth again. The family was terrified. There were a lot of purple-red and black mucosal injuries in the boy's mouth, and at a glance, it was almost filled with various blood blisters. "How could this happen? It didn't seem like it happened before!" "Doctor, please save my child!" The family members panicked, and several elders stamped their feet in anxiety, wishing that these blood blisters would grow on themselves! Xu Qiu called the laboratory department. "Doctor Gu, there is a boy in the emergency department, please help me deal with it urgently." "Okay!" Sure enough, five minutes later, the test report came out. Xu Qiu quickly took a look. White blood cells were normal. Red blood cells and hemoglobin were low, severe anemia. The most important thing is: Platelets 9*10^9/L. (Normal value: 100~300*10^9/L) Such a small number of platelets means that the patient's hemostatic ability is sharply reduced, and intracranial hemorrhage may occur at any time, leading to death. "Fluid replacement." "Infuse platelet suspension." Xu Qiu put down the test sheet, his voice calm and calm. The nurse also breathed a sigh of relief and quickly followed the doctor's instructions. Fortunately, Dr. Xu had anticipated it in advance, otherwise it might take dozens of minutes to wait for the report from the laboratory and then go to dispense the medicine! "Go for a bone marrow examination, it is most likely ITP." Xu Qiu said. ITP, or idiopathic thrombocytopenic purpura. This is an autoimmune disease.
The clinical feature is an abnormal immune system, which leads to thrombocytopenia. The main manifestation is bleeding in the skin and mucous membranes. The most dangerous sign is oral blood blisters - this means that the patient is at high risk of intracranial hemorrhage. When he saw the boy's large-scale oral mucosal damage, Xu Qiu had already guessed that he had severe ITP. However, The final diagnosis requires another bone marrow smear examination. ... This examination usually takes three to seven days to get the results in the outpatient department. But it will be much faster in the emergency department. Especially when the doctor who wrote the order is called "Xu Qiu". At around five o'clock in the afternoon, the boy's bone marrow examination results were printed out. There is an increase in megakaryocytes and maturation disorders; nuclear lobes are reduced, and nuclear-cytoplasmic development is unbalanced... Typical ITP laboratory manifestations. Xu Qiu silently read the check list for a while, and understood why the community hospital said that there was no need for referral. "Prescribe dexamethasone, intravenous drip. After the symptoms are relieved, change to oral prednisone." After the doctor's order was issued. That night, the boy was admitted to the hospital for treatment. The family spent the night worriedly. The next day, the first ray of sunlight in the morning shone into the ward, and the boy's mother woke up. Her eyes were haggard, and she was about to touch her son's forehead, but she was suddenly stunned! After just one night of treatment, most of the bruises on her son's face disappeared! She quickly woke up her husband next to her, and called the boy's grandfather and grandfather. The family admired the child's gradually returning to normal and cried with joy. Xu Qiu originally expected that he might need three days of dexamethasone. As a result, the boy was almost healed on the third day, and his platelets gradually recovered and were out of danger. The family was discharged from the hospital. Before being discharged, the family held Xu Qiu's hand, crying. "Wow, I was so scared, I thought my baby was going to die! I'm sorry, we shouldn't have questioned you!"
"Yes, he is such a good doctor. I will give you a banner when we get back!" "Thank you so much!" The family members apologized and thanked Xu Qiu. After seeing off the family, Xu Qiu returned to the office and sighed softly. This boy had actually been diagnosed with idiopathic thrombocytopenic purpura in the community hospital. This disease has a very low chance of death. However, the acute bleeding stage is very scary. There will be dense bleeding spots on the body, which looks scary. therefore, Many community hospitals and private hospitals are happy to accept such patients. The reason is, it's not too dangerous. What’s more important is that glucocorticoids, such as dexamethasone, prednisone and other drugs, are very effective in treating ITP! It is so obvious that if you take the medicine in the morning, the symptoms will disappear immediately in the evening, and you don’t even need to be hospitalized. This leads to—— Some hospitals will deliberately give some second-line drugs to extend the length of hospitalization. After four or five days, the glucocorticoid will be given again. One injection will take effect and the disease will be cured... certainly, Most tertiary public hospitals disdain this. Because the hospital beds in the top three hospitals are too tight, they have no intention of doing these little tricks. and, ITP patients take medicine, come in today and be discharged tomorrow. They have to write a hospitalization record after staying for half a day, which will put a lot of burden on the doctor. Click—— Xu Qiu closed the boy's hospitalization medical record. This medical record is finally over. Shortly after sending the family away, the emergency department hall ushered in another wave of patients. Before the office doctor could take a bite of food, he was dispatched again. Each doctor leads a lucky audience, Or go to the observation room, or rescue room, or treatment room. A few hours later,
Xu Qiu finally finished her work and was about to go back to the office to rest for a while, when she suddenly stopped.