I can see the status bar

Chapter 269
Performing a biopsy on a patient with symptoms of pulmonary hemorrhage is a highly risky medical decision.Especially when a patient is suspected of having a spontaneous bleeding tendency, this risk is huge-biopsy will cause damage to organs, and biopsy of patients without spontaneous bleeding tendency requires strict bed rest and outside the body Bind something like an elastic band to contain the bleeding.Taking a biopsy on a patient who is already bleeding can lead to more severe bleeding—which can be fatal.

But it is imperative to puncture Wang Lin's lungs.If the cause of his disease cannot be diagnosed, it is obvious that the supplement of suspended red blood cells will not last long.Even if he could hang his life with suspended red blood cells, Wang Lin would still have to die after his kidneys completely failed. A patient with severe anemia due to unknown reasons didn't even have the chance to continue his life with dialysis.

"Of course there are risks." Sun Lien said to Xu Yourong who was about to stop him, "but if we don't do a biopsy, we won't even know what is wrong with him. His blood clotting time is normal, which means that the bleeding is not spontaneous. Biopsies of bleeding lungs certainly have risks, but those risks are acceptable compared to the outcome of doing nothing."

Xu Yourong frowned and asked, "Maybe we can use other methods? Such as PCR or mNGS..."

Sun Lien sighed, "Not enough time. And we don't have relatively few suspects. One PCR test takes six to seven hours, and mNGS takes even longer... and patients may not be able to accept the inspection items worth tens of thousands of yuan. Especially with a project like this that doesn't necessarily check out what's wrong."

"You mean... it's not necessarily an infection?" Yuan Ping'an raised his own question, "I thought you've identified the root cause of the problem as an infection."

"The patient's lungs must have been infected. But whether there is a direct connection between the infection and his proteinuria, or whether the infection is related to severe anemia, is still uncertain." Sun Lien rubbed his forehead in some pain. "The biopsy is the only way we can determine if there is a link between the three."

"Let's do a lung biopsy first." Zhou Ce put forward his own suggestion after consideration, "Continue to monitor the blood routine, at least rule out renal anemia. The kidney puncture damage is too large, and it may not be able to puncture to the patient at one time." The site of the injury. With a lung biopsy, we're at least able to work towards the lesion first."

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"Speaking of which, have you met the patient's family?" Sun Lien and Dr. Pascal went out together.He plans to go out to eat something, and Dr. Pascal has to go out of today's clinic.The two happened to be on the same road, and when they were walking on the road, Dr. Pascal suddenly said to Sun Lien, "I heard that this patient is the one who can be seen first?"

Sun Li'en nodded, "Dr. Xu didn't quite agree with Director Zhou's diagnosis of tuberculosis at first, and then he asked me to have a look."

"So, you haven't met the patient's family yet?" Dr. Pascal touched the top of his head, "After you finish breakfast, it's better to go and see. At least explain to the patient face-to-face It's the attending doctor."

For the attending doctor, it is a kind of etiquette to meet the patient and the family members of the patient in person, and to identify them to each other, and it is also a very important interactive link.Many experienced doctors have emphasized that only after seeing the patient and his family can a patient transform from a simple "case" into a living person.And this kind of meeting is also a kind of respect for the other party.You are my doctor, and we need you to heal.This kind of meeting can also make the patient's family members feel a little more psychologically stable.

"I'll go now." Dr. Pascal didn't have many suggestions for Sun Lien, but every time was important.After pondering for a while, Sun Li'en made a decision directly - anyway, he is not very hungry now.

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"Wang Lin's family, is Wang Lin's family there?" The broadcast sounded in the emergency room.

"Yes, yes." A pretty young girl hurriedly jumped up from her seat with a bag on her shoulders, and ran all the way to the door of the emergency room.

"Hello." Sun Li'en nodded towards the little girl, "I am Wang Lin's attending doctor."

"Doctor, how is my dad?" The little girl didn't have the time to be polite to Sun Li'en. She grabbed the bag on her shoulder, as if trying to keep it from falling off. "He... is he okay?"

Sun Li'en stood at the door of the emergency room, and he stepped aside a little, "It's not appropriate to discuss the patient's condition in public, come with me." He walked in front and led the way, and brought Wang Lin's daughter into the meeting room .

"Please sit down." Sun Lien sat down by himself, "Don't be too anxious. Your father's condition is not very good, but it's not the worst yet."

The little girl is not very old, and the status bar shows that she is only 21 years old, and her name is Wang Xinrui.

And I have Hashimoto's thyroiditis.

Sun Li'en looked at Wang Xinrui in some confusion, then tried to move his eyes away from her head, and began to ask about Wang Lin's illness.

"Has he had a fever and cough for a month?" Sun Lien faced the case, ready to verify the case record again.

"Yes." Wang Xinrui nodded.Although the young doctor asked the same questions as the previous doctors, he could give people a feeling of "checking some kind of guess".This feeling for no reason made Wang Xinrui feel hopeful.

"During this period of time, did he have any symptoms of blood in the stool or vomiting blood?" Sun Li'en planned to solve the rapid anemia that Wang Lin showed first.If the patient had some disorder that caused occult internal bleeding, that might explain why his hemoglobin dropped so much in eight hours.

"No..." Wang Xinrui shook her head. Her mother died early, and she has been living with her father. "Since my mother passed away, my father has quit smoking and drinking. Life is very regular."

Sun Lien frowned, and asked tentatively, "Did your mother die from any disease?"

"No, it was a car accident." Wang Xinrui was a little surprised by Sun Lien's question.This doesn't sound like it has any direct connection with Wang Lin's illness.

"Among your relatives in your father's lineage, do you have any special diseases? For example, you are particularly allergic to certain substances, or have lupus?" Sun Lien quietly squeezed the pen in his hand.He vaguely felt that the answer to this question was very important.

"Yes." Wang Xinrui nodded, "I have Hashimoto's thyroiditis, and my aunt and second aunt also have it. My aunt said a few days ago that she was diagnosed with... xerosis?"

"Sjogren's syndrome?" Sun Lien put down the pen in his hand.He had a very bold guess.

Hashimoto's thyroiditis is an autoimmune disease, while secondary Sjogren's syndrome is the result of highly developed systemic autoimmune diseases.Both of Wang Lin's older sisters have autoimmune diseases, as does his daughter.Taking into account the ubiquitous family nature of autoimmune diseases, Sun Lien believes that Wang Lin may also have some kind of autoimmune disease.It was this disease that caused his pulmonary hemorrhage and suspected glomerulonephritis.

Sun Lien currently has a suspected target - "pulmonary hemorrhage-nephritic syndrome".

Judging from the name alone, its suspicion is also the biggest one.

The exact cause of this disorder, known as Good-pasture syndrome, is unknown.However, it is generally believed that the patient suffered lung injury first, and then caused the antigenic change of the alveolar basement membrane of the patient, thereby producing anti-basement membrane antibodies.And this anti-basement membrane antibody also acts on the glomerular basement membrane at the same time, so the patient will have symptoms of pulmonary hemorrhage and nephritis at the same time.

If the symptoms are correct, the cause of the disease may be Staphylococcus aureus infection.Sun Li'en took out his mobile phone and started making calls, completely ignoring Wang Xinrui who was sitting across from him, who was still in a daze, not knowing what happened.

"Dr. Pascal, please come to the emergency room immediately." Sun Li'en slipped old Pa back without saying a word.Pulmonary hemorrhage-nephritic syndrome is still an autoimmune disease in essence.Dr. Pascal from the Department of Rheumatology and Immunology is the right professional to come to see it.After finishing the phone call, Sun Lien called Xu Yourong again, and immediately stopped the lung biopsy, "The patient may have pulmonary hemorrhage-nephritic syndrome, don't do the lung biopsy, and take blood for GBM (anti-glomerular basal Membrane antibodies) and then a kidney biopsy."

GBM (Anti-Glomerular Basement Membrane Antibody) is the decisive evidence for diagnosing this syndrome, and renal biopsy is to determine how severely this syndrome has caused damage to Wang Lin's kidneys.

The syndrome itself is extremely difficult to diagnose and can be very damaging to the kidneys.If the result of the renal puncture is OK, the disease can be controlled with blood replacement and immune system suppression therapy, and some lucky patients can even heal themselves.But for other people who are not so lucky, the result they need to face may be two nephrectomy, dialysis for more than two years, and then they can prepare for kidney transplantation after the disappearance of GBM (Kang glomerular basement membrane antibody).

After finishing a series of phone calls, Sun Li'en explained his actions to Wang Xinrui, and emphasized, "We are still not sure what stage your father's condition has reached. We can confirm the diagnosis only by testing for specific antibodies in the blood. Through the biopsy, we can judge what kind of treatment he will use later."

"Is this disease... very serious?" Wang Xinrui had some difficulty accepting Sun Li'en's statement about "how far is the disease?" "I also have Hashimoto's, can't the antibody be controlled by taking medicine?"

"The antibodies can be controlled to no longer cause damage to the body, but the original damage still exists." Sun Lien explained, "It's like you nailed a lot of nails into a piece of wood, and taking medicine to control the antibodies is like stopping your hands or even pulling out the nails." There are still many holes in the board. If the holes are not too many and not too deep, maybe the board can continue to be used. But if it is full of nails, then the board is not good. There's no way it's going to function anymore - if you don't replace it, it's just going to be more of a threat to the whole bucket."

Wang Xinrui pondered for a while, then sighed, "Listen to you."

(End of this chapter)