Blood disorders can cause severe vomiting and back pain. In the presence of intravascular hemolysis, free hemoglobin causes nitric oxide depletion, induces smooth muscle spasms that manifest as gastrointestinal symptoms, vomiting, and esophageal spasms that can lead to dysphagia. Bone marrow blood vessels may also have spasms due to this cause, which can lead to low back pain. Severe spasms may lead to "forced position". Maintain a certain position driven by pain and cannot be relieved.

"The transfusion masked the symptoms of anemia due to hemolysis, and nine days later, the previously transfused blood cells died, nitric oxide depletion reappeared, and spasms were induced. Yuan Ping'an is very confident in his own judgment, in fact, Sun Lien also agrees with Yuan Ping'an's opinion - doesn't this just match the "acute hemolysis, hemolytic anemia" in the status bar?

"Plus a coagulation test, and if the clotting time gets shorter, then transfuse two units of suspended red blood cells first. Sun Lien asked Liu Pingchuan for instructions, "I think what Dr. Yuan said makes sense." ”

Red blood cells contain esterases that act as procoagulants in the coagulation pathway. If the patient has hemolysis, the clotting time must also change. At this time, doctors need to weigh whether to replace suspended red blood cells to correct anemia or inject anticoagulants to prevent blood clots.

Starting from Yuan Ping'an's diagnosis, of course, the suspension of red blood cells should be replenished first - after the red blood cells are increased, the nitric oxide in the body can be quickly replenished. This is also a very effective measure to relieve Zhan Hao's smooth muscle spasms.

"The doctors in the second hospital are not stupid. Liu Pingchuan shook his head gently, "Xiao Yuan's idea is very good, but this kind of question is too simple to confirm." If the Second Hospital hadn't figured out what disease he had until now, it wouldn't have been so direct. ”

Although the Second Central Hospital is inferior to the First Central Hospital and the Affiliated Hospital of Ningyuan Medical College in terms of strength and reputation, it is still one of the top 10 excellent hospitals in the province in terms of comprehensive capacity. The reputation and strength of the hospital are not the result of repeated bombardment of advertisements. This is the recognition that all doctors, nurses, auxiliary departments, and even other staff members have worked hard for more than ten years in a hospital from top to bottom. It is the commendation and trophy that doctors get by fighting the disease.

Although the doctors of the Fourth Central Hospital usually look down on the Second Hospital, they are especially unaccustomed to the way they cry and grab food. But if you really want to talk about it, these peers do have two brushes too.

What's more, the Fourth Central Hospital has been thinking about pressing the Second Hospital on the ground and rubbing it, if the level of the Second Hospital is a mess, wouldn't it be hacking itself from another angle?

Liu Pingchuan's attitude is relatively peaceful, anyway, the doctors from the same association look at everyone like that. Therefore, Vice President Liu directly pointed out the logical problem in Yuan Ping'an's diagnosis - if it was really that simple, how could the second hospital not diagnose it?

Sun Lien's opinion is different, Zhan Hao must have hemolytic anemia. The status bar already tells him this directly. But the question is what causes hemolysis. After all, hemolytic anemia, like demyelinating lesions of the central nervous system, is just a description of symptoms. To cure Zhan Hao, the key is still to find the cause.

"New test results. Xiao Guo became the busiest errand in the entire rescue room, he ran all the way back to the conference room with the results he had just printed, and handed the inspection report to Sun Lien.

"ALT (alanine aminotransferase) 196 U/L, TB (TOTAL BILIRUBIN) 64 μmol/L. Sun Lien soon saw two outliers, "There is no problem with the diagnosis of acute liver injury. ”

"Another hospital used GSH (reducing glutathione) in the treatment, which is also symptomatic. Dr. Pascal rubbed his chin. He squinted his eyes and said, "There's nothing wrong with their treatment. ”

Liu Pingchuan thought for a while, "Then we will continue to treat." He leaned back and muttered, "If everything in the second hospital is done right, then why would a patient suddenly become ill after being transferred to us?"

"The most plausible explanation is that there are some things that the Second House is doing wrong, or that they are not doing enough. Yuan Ping'an seems to have no opinion at all about his diagnosis being picked. However, he still had some disdain for the Second Hospital, "If they do everything well, then this patient must not only come to our Fourth Hospital, right?"

"I'll go to the laboratory to see how it's going. Sun Lien pondered for a while, and felt that he didn't seem to have a lot of meaning here. The content of the discussion of this group of scholars was almost beyond his comprehension. The blood routine has not yet come out because of the need to make up a blood smear, and he plans to go to the laboratory to see if he can get first-hand data, and by the way, he will pass by Zhan Hao's bedside to see if there are any new changes in the status bar above his head.

However, the truth is disappointing, and there are no updates to the status bar. But Sun Lien heard a bad news from Shi Yan's mouth that was not too good.

"This sample has obvious hemolytic manifestations, and a lot of reticulocytes and basophilic stippling red blood cells can be seen under the microscope. Shi Yan scratched the back of his head with a pen, looking a little absent-minded, "I suggest doing a mechanical brittleness experiment to supplement it." ”

"How long will it take to do this?" Sun Lien asked, "Do you think it's necessary?"

"According to the requirements, this experiment should take at least 48 hours. The presence of reticulocytes and basophilic stippling red blood cells is a sign of anemia. Reticulocytosis means that the patient may have hypertrophic anemia or hemolytic anemia, and from the samples sent, it should be clear that hemolytic anemia is correct. Shi Yan explained, "However, there are more possibilities for basophilic stipple erythrocytosis, such as heavy metal poisoning, organic compound poisoning, hemolytic anemia, pernicious anemia...... Anyway, there are many reasons for this. If you want to figure out the direction, you must first determine the cause of hemolysis. ”

"I'm worried about that, too. Sun Lien spread his hands helplessly, "This patient is the brother of the war army, and when I went to his store yesterday, he was still asking me about my recovery......

"Rehabilitation?" Shi Yan frowned, "Why is it related to rehabilitation? Isn't this a hemolytic anemia?"

"There are also symptoms of demyelinating lesions of the central nervous system. Sun Lien told Shi Yan about the situation, "At first, the second hospital thought that the acute abdomen was caused by acute hepatitis, and they felt that the situation had been controlled. I guess I might focus on the weakening of the muscles in the lower limbs in the future, right?"

Shi Yan shook his head and said, "Then when the battle army sends his brother to our four courtyards, you will focus all your energy on hemolysis?"

Sun Lien was about to refute, but suddenly felt that something was not right. It was a very subtle feeling, so subtle that it required him to turn his head and think about it without saying a word.

"It's not just hemolysis......" Shi Yan didn't see Sun Lien's expression and movements clearly through a layer of glass, and thought that this guy was criticized by himself to the point where he had nothing to say, so he fell silent. Unexpectedly, he just said five words, but in exchange for Sun Lien's voice, "Shut up!"

Shi Yan touched his nose and was silent. He could see that Sun Lien seemed to be trying to think about something. When they lived together in the dormitory before, if Sun Lien had this situation, he was wrestling with some difficult problems, and he might have caught the clues to solve them. It's best not to bother him at this time.

"No...... Still can't figure it out. After working hard for a while, Sun Lien shook his head and sat down. He seemed to have grasped an important point just now, but when he really wanted to go back and pull it out, he couldn't even think of what the point was. Sun Lien grabbed his hair in frustration, and even wanted to blame Shi Yan for interjecting out of place.

Shi Yan walked out of the inspection window, and by the way, he also brought out a round chair lift with wheels, "It's normal if you don't understand." You're a little Guipei, not the reincarnation of Conan, and you can figure out the details of everything in a flash of inspiration. Although it is mockery, the core content is reassurance.

"Let's do the mechanical brittleness experiment. Sun Lien shook his head and stood up, "In the current situation, it's good to have one more hint." ”

"Actually, you should first think about what is the cause of hemolysis in this patient. Shi Yan stood up and walked back towards the door of the laboratory department, "There are generally only a few causes of hemolysis, mechanical hemolysis, osmotic pressure change hemolysis, microbial hemolysis, and toxic hemolysis. He slowly wandered into the laboratory department, "Only by figuring out the cause of hemolysis can we diagnose what disease he has, right?"

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Twelve hours passed, and the army was busy opening a shop and taking care of his son, so he was not in the hospital. And the entire treatment team, except for Dr. Pascal and Liu Pingchuan, the rest of the people have never left the hospital. Even lunch and dinner are settled by takeout.

"It's not a way to go on like this. Xu Yourong stood up and stretched, she looked at the diagnosis on the whiteboard that was drawn one item after another, and then another item was crossed out, "I'll go out and get some fresh air." ”

Yuan Ping'an took the opportunity to announce that he was going to the toilet, while Zhou Ce was even more simply, "I'll go back and take a shower and change my clothes." ”

The members of the treatment team left one after another, leaving Sun Lien alone and stubbornly standing in front of the whiteboard and silent. He also wanted to just leave it alone for the time being, but as the "head" of this treatment group, everyone else could go first, but Sun Lien himself definitely couldn't.

If even he gives up, then who will treat Zhan Hao?

Hu Jia quietly approached from behind and hugged Sun Lien. She had been standing at the door of the small conference room for almost half an hour. When Xu Yourong went out, she walked in quietly.

Sun Lien, who was suddenly embraced, was startled, and was slightly relieved when he turned his head and found that it was his girlfriend. The right hand was raised up very smoothly, stroked Hu Jia's head and rubbed it, "Why are you here?"

"Let's take a look at my family's Director Sun. Hu Jia saw that there was no one else in the small conference room, so she simply leaned up and kissed her generously. Then he looked at the whiteboard with a curious look and asked, "This patient is troublesome?"

"You also heard from the war army yesterday. Sun Lien smiled bitterly, "It took nine days on the second side of the hospital, but we didn't even know what disease he had, if we can figure it out right away, it wouldn't be normal, right?"

Hu Jia glanced at the whiteboard, which listed several possible causes of hemolysis according to their guesses. And then almost every possible cause is crossed out.

"Good work. Hu Jia rubbed Sun Lien, and then asked, "You still have to work overtime tonight, right?" After speaking, she took out a small stewed pot from behind her. "This is the porridge with preserved eggs and lean pork I made at noon, for you to make supper. ”

"I happened to be hungry. Sun Lien replied very shamelessly, in fact, he was thinking about the diagnosis all over his mind, not to mention wanting to eat, he couldn't even say whether he was hungry or not now.

"Originally, I also braised some meat and wanted to bring it to you. But the coating on the inside of the insulated box I used was off, and I was worried that it might not be good for you to eat......" Hu Jia said a little embarrassed, she had marinated a lot of meat dishes such as pig's trotters, but she didn't bring them. While explaining, Hu Jia secretly decided that he must go to the supermarket to buy a new set of thermal boxes and other things.

Sun Lien was stunned for a moment, and then stunned. The expression on his face ranged from a smile to a frown.

"What's wrong?" Hu Jia couldn't help but be a little worried as if her boyfriend had changed his face. Unexpectedly, Sun Lien hugged Hu Jia and laughed while hugging him, "My dear, you are really a genius!"