The speed at which a GBM test can be done depends on the means of inspection. Seriously, there are really not many hospitals that can do GBM antibody testing, and even fewer hospitals that can do more advanced colloidal gold methods. The Fourth Central Hospital can only do it – check for antibodies by immunofluorescence. It takes half a day from the delivery of the specimen to the test results.

Kidney biopsy results are much quicker – it depends on how long it takes for pathologists to recognize what the specimen is.

Pathologists have always called themselves "doctors of doctors", whether in internal medicine or surgery, the diagnosis of many diseases depends on their observation and judgment under the microscope. If anyone can tell what animal the hair belongs to by a single hair, it must be a pathologist.

This time, the doctors, who like to look for evidence under the microscope, found a very disappointing result. "Fifty percent of the crescents were formed in the sample, and immunoglobulin G was deposited in a linear manner along the glomerular capillary loops on electron microscopy. ”

The crescent is a crescent-shaped body formed around the capillary plexus by the epithelial cells of the glomerular sac wall that proliferate significantly, accumulate into layers, and form around the capillary plexus. It usually means that the kidneys have been severely damaged. The linear deposition of immunoglobulin G confirmed Sun's suspicion that this was a classic case of pulmonary hemorrhage-nephritic syndrome.

Pulmonary hemorrhage-nephritic syndrome itself is extremely difficult to diagnose for the first time. Almost all initial diagnosis of pulmonary hemorrhage-nephritic syndrome is misdiagnosed as something else. Two or three days after the patient is admitted to the hospital, the symptoms do not improve, and the doctors begin to suspect pulmonary hemorrhage-nephritic syndrome.

It's not that it's so difficult to diagnose – a kidney biopsy can confirm about 80% of cases of pulmonary hemorrhage-nephritic syndrome. The main reason is that the incidence of the disease itself is not high, and the symptoms shown by the patients are too similar to those of tuberculosis, idiopathic pulmonary hemeosis, polyarteritis nodosa, systemic lupus erythematosus and other diseases. Moreover, the disease progresses rapidly, the prognosis is poor, and many patients may even die before the cause of the disease is detected. However, due to the limitations of the domestic environment, the vast majority of patients' family members will not choose autopsy to determine the cause of the disease when they are patients. So it's hard to say exactly how much true incidence.

Because the disease is so featureless, and the process is very vicious, this also leads to many times, doctors have to face the fact that the patient dies without having time to consider other possibilities. In fact, even Zhou Jun and Xu Yourong, Zhou Ce, Yuan Ping'an, and even Dr. Pascal almost fell into this trap - they insisted that Wang Lin's main problem was infection before the results came in.

Sun Lien was happy for two minutes, and then suddenly realized a bigger problem.

Wang Lin's status bar clearly stated that he had a Staphylococcus aureus infection.

For pulmonary hemorrhage-nephritic syndrome, patients need to receive a high-dose glucocorticoid pulse, combined with immunosuppressants and plasma exchange, to effectively relieve symptoms and prolong life. But this treatment adds fuel to the fire. Staphylococcus aureus infections can cause very serious illnesses, ranging from lung abscesses and sepsis to systemic multi-organ failure, and if the bacterial infections are not suppressed immediately with antibiotics, Wang Lin's death is only a matter of time.

However, for the treatment of infection, it means that no immunosuppressive action can be performed. Otherwise, the antibiotic will not only fail to exert the desired effect, but may continue to deepen the original kidney damage due to nephrotoxicity or hepatotoxicity.

In another dilemma, Sun Lien grabbed his hair in pain. The most troublesome thing is that the culture results of the lung lavage fluid have not yet come out, and now only he knows that Wang Lin also has a Staphylococcus aureus infection.

You can't just treat with this result, you have to wait until the culture of the lavage solution is made. Sun Lien made a decision.

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"Staphylococcus aureus infection?" In the examination department, Zhao Weiguo put down the newspaper in his hand and looked out from above his glasses. The laboratory doctor holding the test report at the door nodded, "It's the examination request from Dr. Sun Lien of the emergency department." ”

As soon as he heard Sun Lien's three words, Zhao Weiguo frowned. He took off the reading glasses he was wearing on his face, and after a moment of silence, he said, "Give me a copy of all the test results and materials of his patient." ”

The examiner was stunned for a moment, then nodded. When he turned around and was about to walk out of Zhao Weiguo's office, Zhao Weiguo spoke again behind him. "I'll give him the results in two hours. ”

After about 20 minutes, all of Wang Lin's test results appeared on Zhao Weiguo's desk. He picked up the report and read it roughly, then suddenly stopped at the results of the renal biopsy. The expression on his face was very complicated, with shock, bewilderment and a hint of jealousy.

"Can the first diagnosis confirm the diagnosis of pulmonary hemorrhage-nephritic syndrome, and also test for Staphylococcus aureus infection?" he muttered to himself, then shook his head with a smile, "I don't know if he was lucky or unlucky." Zhao Weiguo's plan is very simple, after the doctor confirms the type of patient's disease, he will directly start to decide on treatment. For pulmonary hemorrhage-nephritic syndrome, the most mainstream and effective treatment is immunosuppression and high-dose hormone pulse combined with hemoexchange. But as long as Sun Lien dares to take these treatment methods, the patient will definitely die. Without immune system control, Staphylococcus aureus that has infected Wang Lin's lungs will kill him in the shortest possible time.

The laboratory department was asked to do a bacterial culture, but before the results were available, they switched to immunosuppressive therapy. This is definitely medical malpractice – the doctor did not avoid the risks that had already been foreseen. Based on this alone, as long as the patient dies and instigates the family to sue, he, Zhao Weiguo, can beat Sun Lien into the eighteenth layer of hell without even getting his hands dirty, and he will never be able to turn over.

If it had been half a month ago, he would have done this. Just because Sun Lien instigated Liu Pingchuan to have a conflict with himself, Zhao Weiguo had the intention to kill Sun Lien. One of the laboratory departments is his independent kingdom, and it is absolutely impossible for someone to go wild in his own one-third of an acre of land - even if it is the vice president who comes to spread the wild. can't deal with Liu Pingchuan, if he doesn't suppress Sun Lien again, how can he continue to maintain his position in the laboratory department?

But this half month is different. Takeda Pharmaceutical's Kobayashi Feng trusted several layers of relationships and hired Zhao Weiguo's son and daughter-in-law into the company. Basically don't have to do anything every month, and the two of them can get a salary of about 6 million yen. Of course, such a generous remuneration is not given in vain, Kobayashi Feng directly explained that he wanted Zhao Weiguo to provide all of Sun Lien's examination and diagnosis records, and he must be "the most wonderful ones".

Xiao Lin Feng is probably planning to praise Sun Lien. Raise this young and promising little doctor to a high position, and then cheer for Takeda. This is Zhao Weiguo's final judgment on Kobayashi's series of behaviors. He also had to admit that Kobayashi Yutaka's eyesight was really good. In the past half a month, Sun Lien has continuously diagnosed many difficult patients. This time it was even more remarkable, he even made the first diagnosis of pulmonary hemorrhage-nephritic syndrome.

Zhao Weiguo's heart is actually very contradictory, if he really wants to fix Sun Lien, he is happy. But the job that my son and daughter-in-law have just arrived will definitely be in vain. But if he follows Kobayashi's baton around, and when Sun Lien really gains a firm foothold, who knows if he will turn his head and find trouble for himself?

After pondering for a while, Zhao Weiguo sighed and decided to go to Sun Lien in person. In case he starts immunosuppressive therapy, then he can use this report to sell him a favor of "concealing the report". If not, then use this report to show that you value the emergency department. Left and right, advance and retreat. Zhao Weiguo's old fritter is this plan.

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"The blood routine report an hour ago has made it very clear, HB (hemoglobin) is 55g/L, and we have given him eight units of suspension red blood cells. If it drags on any longer, people will die!" Yuan Ping'an said urgently to Sun Lien in the conference room, "The results of the examination have confirmed your guess, it is indeed pulmonary hemorrhage-nephritis syndrome." Why don't you treat it right away?"

"The number of WBCs (white blood cells) in patients is also increasing, reaching 11.4×10^9 cells/L. Sun Lien is still trying to convince Yuan Ping'an, "He is likely to have other problems, and at present, the biggest possibility is that he is infected." ”

Dr. Pascal is also supportive of immediate immunosuppressive therapy, "Patients with autoimmune diseases may have ANGA (antineutrophil antibodies) in their blood, and although uncommon, it is possible for ANGA to be produced in patients when they are continuously transfused with suspended red blood cells. That is, the level of white blood cells in his body may be higher than the data we are seeing. I would also recommend postponing immunosuppressive therapy until the results of the lung lavage fluid are available. It's worth the wait. ”

Zhou Jun sat on the stool and sighed, and he said to Sun Lien seriously, "If you have time recently, really find a temple to worship." The incidence rate of 1 in a million can be met by you, so why don't you buy a lottery ticket with this good luck?"

"The odds of winning the lottery are 1 in 2,140,000. Numerically, it is at least twenty-one times more difficult than this patient. Xu Yourong was reading the paper, and after hearing Zhou Jun's words, she added a sentence without changing her face, "When Dr. Sun encounters this kind of patient 20 more times, he should go and buy a lottery ticket." ”

Sun Lien was meowed by this group of bigwigs, and he didn't dare to say a superfluous word. Anyway, as long as you don't give Wang Lin glucocorticoids, even if you scold him for another two hours, Sun Lien will admit it - the value of Dr. Guipei's existence is to pretend that his grandson was scolded by a senior doctor. It's also quite cost-effective to save a human life while performing normal duties.

The door of the conference room was suddenly pushed open, and a middle-aged man who looked quite energetic broke in from outside the door, he looked around nervously, opened his mouth and asked, "Has Wang Lin's treatment started?"