The answers to many mystery stories seem so illusory until they are revealed, but once the pipe-smoking detective tells the story in the fireplace and on the single-back couch, the reader tends to have two feelings – "Is this okay?" ...... Oh yes!"

If Rawls's illness is written as a story, then readers are likely to be confused, "What does this author want to say?"

The two originals found by Sun Lien are the basic evidence to prove his inference. His reasoning still needs to be proved by conclusive evidence, but the originals of these two blood routines are the prerequisites for his entire diagnosis—if these two blood routines were not quickly obtained with an analyser, then Sun Lien's bold speculation is nothing more than an ethereal illusion.

"Two hours?" General Peng, whose momentum was suppressed, frowned, "Doctor Sun, if you don't think you have the ability to judge your condition, I can prepare for a transfer right now." He thought Sun Lien was giving up on himself.

Sun Lien smiled and shook his head, "I have some thoughts about his illness now, if the results of the test are different from what I imagined, then I am incapable." He said to General Peng, "If you have anything else, you can go first, and I'll arrange for an examination - the new results will be available in two hours." ”

"So...... What do you understand?" Xu Yourong stood at the door of the small conference room, and as soon as Sun Lien went out, he was startled by the ambush of Deputy Chief Physician Xu. Xu Yourong didn't make any jokes because Sun Lien almost fell, she asked Sun Lien very seriously, "I have discussed with Dr. Yuan and Zhou Ce for a long time, but we still can't figure out what is wrong with this patient. ”

Sun Lien leaned against the wall and slowly climbed up, he used his mind to pull back half of the soul that had floated out of his mouth, and sighed, "Sister Xu, people can be scared to death." The feeling of being scared half to death by the drug trafficking girl who came to look for a dog in the middle of the night returned to Sun Lien's body, and without looking in the mirror, Sun Lien could guess that his head must be in a state of "adrenaline overproduction" now.

"It's your sudden inspiration that's scary. Xu Yourong seems to have really been hit - although it doesn't look obvious from the outside. "The three of us, and even Rachel combined, don't have a reliable guess of the direction, and you dare to say that you can figure out the reason in two hours......"

Sun Lien had to speak out to correct Xu Yourong's cognitive misunderstanding, "I mean, my guess can be confirmed within two hours, if it is not confirmed in more than two hours, then there is no need to leave others to continue to waste time - anyway, I have no other ideas." ”

Xu Yourong was stunned for a moment, "So you're planning to make a desperate gamble and break the jar?"

"The first half is true, but the second half is not like that. Sun Lien laughed and corrected Xu Yourong's idiom usage, "I am still quite confident in this guess." ”

"What is it?" Xu Yourong couldn't help it, "Is it intravascular hemolysis caused by pneumonia?"

"No, actually, if you had consulted with Dr. Pascal instead of a few of them, you might have been able to find an answer. Sun Lien smiled very cheaply and sneered, "Foreigners always say that they can't care about skin color or race. But they always overcorrected – the patient's greatest trait was so overlooked, that he was black. ”

"Does it have anything to do with race?" Xu Yourong was a little stunned, "But the theory of race ......"

Sun Lien interrupted Xu Yourong's speech for the third time, "I'm talking about objective physiological differences, not the basis for distinguishing genocide." He's black, so his hemoglobin level should be about 15 to 30 percent higher than ours. Also because he is a black man living in a region of malaria, this group has evolved a physiological defense mechanism against malaria. ”

Xu Yourong suddenly realized, and Sun Lien said in unison, "Sickle cell disease!"

Although he knew the answer, Xu Yourong still didn't believe Sun Lien's judgment. "Shouldn't it? Didn't you do two blood tests? The sickle-shaped red blood cells are obvious under the microscope to ......."

Sun Lien took out the two routine blood test sheets in his hand, "So I dared to make this speculation after seeing these two test sheets." Whether it is the hospital in the training ground or the blood routine test report issued by the laboratory department of our hospital, the blood cell analyzer is used. ”

The hematology analyzer is a good thing, and the laboratory department of the training ground hospital and the fourth central hospital use a five-differential blood cell analyzer. With only about 20 microliters of peripheral blood, the analyzer is able to report 15 blood cells in one minute, and whole blood C-reactive protein index in three minutes. It's fast, it's accurate, and it's complete. This greatly relieves the pain of laboratory doctors making blood smears and then counting the cells little by little under the microscope. At the same time, because the number of blood samples required is small, it can also save the patient more pain. But most importantly, the ability to complete most blood tests in less than three minutes makes the blood analyzer a lifesaver in the emergency department.

The problem is that hematology analyzers can't identify red blood cells that are defective in shape.

Although advanced blood cell analyzers can already identify abnormal cell tissues such as giant platelets, sickle cells are still not included in the scope of blood cell analysis. In general, patients with sickle cell disease or sickle cell anemia still rely on the eyes of the examiner. Unless sickle-shaped cells are seen in the blood smear, it is impossible for the laboratory to report the symptom to the doctors.

The laboratory department of the training ground hospital and the fourth central hospital fell into this blind spot. What they detected with a blood cytometer did not fully cover Rawls's symptoms, and they also masked his most important illness. This error keeps doctors torn between the dead-end of infections and autoimmune diseases. And the most frustrating thing is that sickle cell disease and sickle cell anemia are very rare diseases in China. The disease has the highest incidence in Africa.

According to research, sickle cell disease is generally believed to be caused by the replacement of valine with valine, the 6th amino acid of the β chain in the patient's chromosomes, forming abnormal hemoglobin S, which replaces normal hemoglobin. As the partial pressure of oxygen drops, the hemoglobin S molecules interact with each other to form a helical shape, which distorts normal red blood cells into sickle cells. Because the mechanical morphology of sickle cells changes, the cells themselves are more susceptible to symptoms such as hemolysis or clogging of capillaries.