This doctor has a system

Chapter 288 277. Anemia?leukemia?
"What the hell, I'll never drink randomly again." Wu Sidao said weakly.

"It's normal for your ability to decline as you get older. There's no need to pay too much attention." The doctor in charge advised, "This is not what people do for a living."

"If that doesn't work, let's continue drinking Chinese medicine." Wu Sidao thought for a while, "Doctor, do you have any safer medicines in this regard?"

"You are so persistent!" The bed doctor was very impressed.

"We don't have such medicine here. Let's do this. I'll leave you my contact information. If you find anything useful, let me know."

While the two were talking, a middle-aged man hurriedly walked in.

"Old Wu, are you okay?"

"I'm so NMGT!" Wu Sidao was very excited when he saw the person coming, "You almost sent me away, do you know?"

The person who came was none other than the boss surnamed He who gave Wu Sidao medicinal wine. He kept company with him and said that he had covered all the medical expenses.

Boss He was almost frightened to death when he learned the news that Wu Sideo almost died. He gave three people the medicinal wine that day. Fortunately, only Wu Sideo drank it, and the others didn't have time to use it.

"Old Wu, you are so great!"
-
"Who is this patient?" As soon as he arrived at the department, he noticed a young man in the rest area next to the small nurse station.

He looked to be no more than 18 years old, and he was in his prime of life, but he looked sickly, with a haggard complexion, and was wearing a black hat.

Even if you are not a doctor, you can feel that there must be something wrong with this boy's body.

"It's a feverish patient." Wang Wenhao said, "The child's parents are from the same hometown as Director Chen."

Gao Feng felt a sense of gratitude to Director Chen. Although he went in to use the sewing machine, he was still silently contributing to the cause of general medicine.

Director Chen, you are a good person.

"How long has the fever been present? This patient seems to be in a very bad mental state." Gao Feng said.

"He has leukemia." Wang Wenhao said.

Patient Zhang Yu, male, 16 years old, went to the local central hospital six months ago due to fatigue and anorexia, and was diagnosed with leukemia. He then underwent chemotherapy for half a year.

"The family members said they felt that the child's condition had not improved." To be precise, the family members believed that the child's condition was more serious than before. Before, he just felt weak, but now he is bedridden, his hair is falling out, and his limbs are obviously weak.

The child's mother was deeply hit by this incident, suffered mental problems, and is currently in a state of depression.Her husband was worried about her, so he took his whole family to live with his mother-in-law's house in Zzhou for a while.

Three days ago, Zhang Yu developed a fever, accompanied by an obvious cough and yellow phlegm. At this time, his father thought of his fellow villager, Director Chen, and brought the child over without getting through the call.

The nurse measured his body temperature at 39.8°C, and Wang Wenhao prescribed a chest CT examination. It showed pneumonia in the lower left side, which was quite extensive, and it was recommended that he be hospitalized.

In that case, there is nothing special about it.

"Let's find a place for the child to lie down first. I think he feels very uncomfortable." Gao Feng said.

"The nurse is making the bed." Wang Wenhao replied.

"Fatal misdiagnosis: Zhang Yu's situation is very bad. This 16-year-old young man may have suffered a fatal misdiagnosis. Please find out the specific situation for him in time. You can get 20 skill points for completing the task. If you fail, the skill points will be deducted. 20 o'clock." The system suddenly issued a task.

Gao Feng, who had just raised his front foot, was stunned.

"Wen Hao, please turn on his chest CT scan. I want to take a look."

Wang Wenhao hurriedly turned on the computer and pulled up the CT images.

It was indeed a lung infection. Gao Feng took a closer look and found that there should be no misdiagnosis.

Could it be that the diagnosis of leukemia was wrong?He was shocked.This is impossible!Gao Feng immediately denied his speculation.

Leukemia is a malignant tumor of the blood system, also known as blood cancer, and it is a very serious disease.

As a malignant clonal disease of hematopoietic stem cells, leukemia cells are stagnated at different stages of cell development due to uncontrolled proliferation, differentiation disorders, and blocked apoptosis.In bone marrow and other hematopoietic tissues, leukemia cells proliferate and accumulate in large numbers, inhibiting normal hematopoiesis and infiltrating other organs and tissues.

The diagnosis basis for leukemia is very strict, so Zhang Yu did a bone marrow biopsy and an immune typing test.

The so-called immune typing test uses flow cytometry to detect the characteristic antigen expression patterns of leukemia cells through a variety of specific antibodies in the patient's bone marrow or peripheral blood samples, thereby identifying the source of the leukemia cells and determining their unique expression. type.

This method plays an important role in clarifying the type of leukemia and also has important clinical value in testing the efficacy after treatment.

Zhang Yu's test report clearly stated: M2a leukemia.

Few doctors have the courage to doubt such a pathological diagnosis, and Gao Feng is no exception.

"When you draw blood, you can check in more detail." Gao Feng hesitated, "I feel like it's hard to say whether he has leukemia or not."

"What?" Wang Wenhao was stunned, "Director, what do you mean?"

"It's not interesting. I just think we should confirm his leukemia diagnosis again."

"Is this necessary?" Wang Wenhao blurted out.

"Let's check it out." Gao Feng didn't explain much.

Soon, Zhang Yu's blood test results came out.

"The anemia is quite obvious." Wang Wenhaohui reported, "It looks like macrocytic anemia."

Common clinical classifications are based on red blood cell morphology, and anemia can be divided into three categories: macrocytic anemia, normocytic anemia, and microcytic hypochromic anemia.

Macrocytic anemia: Macrocytic anemia refers to the general term for anemia in which the average red blood cell volume exceeds the upper limit of normal levels (>100fl) and the average red blood cell hemoglobin concentration is 32%-35%. Common ones include megaloblastic anemia and myelodysplasia syndrome. levy etc.;
Microcytic hypochromic anemia: It is a type of anemia in which the volume of red blood cells becomes smaller and the central light-stained area expands due to insufficient raw materials for the synthesis of hemoglobin.The average red blood cell volume is <80fl, and the average red blood cell hemoglobin concentration is <32%, including iron deficiency anemia, sideroblastic anemia, etc.

Zhang Yu's blood routine showed that the mean corpuscular volume (MCV) was >100fl, the red blood cell distribution width (RDW) was increased, and it was accompanied by a slight decrease in platelets, which was consistent with the laboratory characteristics of large cell anemia.

"What about the peripheral blood cell morphology analysis results? Are there any abnormalities?"

"No, we didn't see primitive or immature cells." Wang Wenhao said, "This doesn't mean anything. After all, the patient has been undergoing chemotherapy for half a year, so the condition should be initially under control."

Is it really?Gao Feng wondered, if the disease was under control, why did the patient's general condition get worse?This doesn't make sense.

"Go and call the family members." He said to a student.

The student ran out with a cry, and when he came back, he was followed by a middle-aged man who looked tired.

"Doctor Wang, what do you want from me?" "Hello, it's our director who wants to see you." Wang Wenhao motioned for him to sit down, "This is Director Gao of our General Medicine Department."

"Hello, Director Gao." Zhang Yu's father was very polite, although he felt that Gao Feng was a bit too young.

"Dad Zhang Yu, it's like this. I have some objections to the diagnosis of my child's leukemia. Can you go back?" Before Gao Feng finished speaking, Zhang Yu's father stood up with a cry.

"What did you say? Objection? What objection?" He was a little excited and even wanted to hold Gao Feng's hand.

"Don't be like this." Wang Wenhao patted him on the shoulder, "Let's listen to what Director Gao has to say first."

"How should I put it? I just did a comprehensive physical examination on the child. Combined with the results of the blood draw, I feel that the diagnosis of leukemia seems to be a little bit wrong," Gao Feng said. "Of course, this is just my personal guess and diagnosis. I don't dare to do so at the moment." Guaranteed for you."

"Can you see if you can go to the pathology department of the local central hospital and borrow this original bone marrow slide, and then take a look at it in our pathology department."

"Okay! I'll go now." Zhang Yu's father turned around and rushed out.

"Hey, you" Wang Wenhao sighed, "this person is also impatient."

In fact, Zhang Yu's father used to be a very Buddhist person, doing everything slowly, but since his son was diagnosed with leukemia, he has changed. He has become irritable, impatient, and often loses his temper.

Only when facing his son will he regain his previous patience.

"I'm afraid that if I borrow the film back, our pathology department will still diagnose it as leukemia." Wang Wenhao was very worried, "I'm afraid he will collapse all of a sudden."

Zhang Yu's mother is in a depressed state now. It would be unavoidable if something goes wrong with his father.
After hearing what he said, Gao Feng also felt a little regretful.

"I'll ask my brother to go with him." Li Youliang on the side saw his worry, "It's easy to have problems when people are in a hurry. Let Li Zheng drive him and chat with him in the car."

"Okay!" Gao Feng motioned for him to hurry up.

"No need, you are so busy, I will be fine." Zhang Yu's father didn't want to trouble so many people.

"I drive quickly. We can return this afternoon." Li Zheng gestured for him to get in the car. "It's easy. I just happened to go over there to do some errands. I'm on my way."

Both of them were silent along the way. Li Zheng still remembered his brother's instructions to enlighten the other party.

This is hard for him. He is usually a boring gourd and doesn't know how to comfort people.

"Well, brother, how old are you this year?"

"39."

"Oh, I'll be 40 next year."

"Ah."

Forget it, I'd better stop talking. Li Zheng began to concentrate on driving, and the accelerator was stepped on. The original 4-hour journey was shortened to 3 hours.

The process of borrowing the film was very smooth. Zhang Yu's father just showed his household registration book and ID card, and the doctor from the pathology department of the Central Hospital quickly packaged the original bone marrow film to him.

After getting the things, Zhang Yu's father's hands were shaking badly.

"Are you okay? Do you need a rest?" Li Zheng asked.

"No." He declined.

"Actually, I'm just scared." Zhang Yu's father suddenly said after a while, "I really hope the previous diagnosis was wrong, otherwise"

"People still have to look forward. No matter what the outcome is, you still have to take care of your body." Li Zheng thought for a long time and said this, "Actually, you are still quite young, so focus more on the future."

"If the child is gone, we will have no future." Zhang Yu's father said after being silent for a while.

Director Ding of the Pathology Department was already looking forward to it. He called over all the doctors in the department who had some spare time. At the same time, he also got in touch with the person in charge of a pathology center. The other person was his classmate and was very good at leukemia. diagnosis.

"You can rest here for a while. The experts will consult together." Wang Wenhao said to Zhang Yu's father, "Would you like something to eat?"

The latter shook his head.

"This is megaloblastic anemia, which is general anemia. What kind of leukemia is it?" Director Ding took a closer look and said, "You guys should also take a look."

"Yes!" A gray-haired doctor shook his head, "Who reported leukemia? Isn't this nonsense?"

After a discussion, Director Ding informed Gao Feng of the result in a serious manner.

When Zhang Yu's father heard the news, he immediately fell down from the chair. His head was hit hard by the armrest, and he was bleeding. Wang Wenhao quickly used the gauze in his pocket to hold him down.

"Are you OK?"

Zhang Yu's father looked blank for a while, and suddenly burst into tears.Gao Feng and others felt uncomfortable seeing him like this.

"Their Central Hospital is in trouble right now." Director Ding of the Pathology Department whispered, "The patient was diagnosed with megaloblastic anemia and became leukemia, and the patient was given chemotherapy for more than half a year."

"Eh?" He smacked his lips.

The harm to the patient and his family is simply tragic. If the system had not prompted him, the patient might have died tragically during subsequent chemotherapy.

This is too scary.

Li Youliang couldn't help but feel glad that he was not engaged in clinical practice now. The misdiagnosis of this patient made him break out in a cold sweat.

Due to the limitations of modern medicine, it can be said that medicine’s understanding of the human body has reached [-]% so far, which is optimistic.There are so many causes of disease and the mechanisms are unknown.

So this creates a huge problem: the misdiagnosis rate in hospitals remains high.

According to statistics, the hospitalization misdiagnosis rate in the United States is about 35%, while the hospitalization misdiagnosis rate in the UK is about 40%.The hospitalization misdiagnosis rate in China is about 30%.
The shortage of medical resources and low economic level will also lead to an increase in the misdiagnosis rate.

Many examinations are very expensive, and a considerable number of them are invasive, which can also cause harm to patients.

But generally speaking, most misdiagnoses may not cause great harm to patients, but Zhang Yu's situation is obviously not among the majority, and the child is almost dead.

"A patient with giant juvenile anemia was turned into this" Wang Wenhao couldn't calm down for a long time, and he was even a little angry.

Zhang Yu's father left with the original bone marrow slices. He still dare not tell his wife about it.

(End of this chapter)