latelenovela Chapter 437
Chapter 437
Lin Feng looked at the little boy in front of him.
Finger pain,
And it's been for years, and it hurts repeatedly from time to time!
What disease comes to mind in the first reaction?
That's right!
Rheumatism!!
Think about the rheumatism of the elderly, isn't it painful from time to time?
Do not think that rheumatism is a disease of the elderly, children also have rheumatism.
For example:
Psoriatic juvenile idiopathic arthritis...
Juvenile idiopathic arthritis...
Lin Feng looked at the child's mother.
"The child has been sick for so many years, he should have visited the hospital, right?"
"Yes."
"Do you have medical records?" Brought it? "
"Brought ..."
And then
The little boy's mother pulled out a small book from her handbag.
The cases are neatly organized and very careful.
Lin Feng was suddenly full of good feelings, and he was most afraid that those patients with messy medical records were the patients.
Flipped over,
Then it was found that the "full set of rheumatic immunity" had been examined.
All indicate negative.
That is, rheumatism is excluded.
"Is it possible to have gout?"
Lin Feng thought about it and felt that it was unlikely, although children can also cause gout because of dietary problems, but the parts of gout are mostly in the knees, elbows and the like, and the little boy in front of him only has finger pain? ?
"Let me ask again, only the fingers hurt?"
"And sore toes..."
"Do you have big joints like elbows and knees?"
"No, I haven't tried..."
Young mother, directly denial.
Lin Feng thought about it and ruled out gout for the time being.
"What medicine have you taken before?" Does it work? "
Speaking of which, young mothers are a little resentful.
"Every time the doctor prescribed a lot of medicine, and later found that the medicine was useless, and after a few days of the attack, the pain disappeared, wasting a lot of money... Dr. Lin, when you wait to prescribe medicine, trouble to prescribe some cheap medicine, my family is very poor, and it is difficult for children to go to school..."
The young mother said a little ashamedly.
Lin Feng nodded: "Good..."
There are indeed many drugs with similar efficacy, and the price difference will be very large, some for a few cents, and some directly hundreds of yuan... There are many doctors who like to prescribe expensive drugs, and there are a bunch of them, which makes many patients very disgusted.
Next
Lin Feng asked some questions.
Didn't ask for something.
Allergic?
Looking closely at the little boy's fingers, I couldn't see any allergies such as hives... Can not see.
Lin Feng: "Any other medical history?" and family history..."
Young mother: "Yes, my husband has thalassemia... Then the doctor later diagnosed my son, who also had thalassemia..."
thalassemia
This is an examination to be done when the mother is pregnant, and it is put in the pregnancy screening, indicating that it is a very troublesome disease.
It is caused by anemia or pathological conditions caused by the absence or deficiency of one or more globin chain synthesis in hemoglobin. (Genetic inheritance)
If you say so,
The pale face of the little boy in front of him may not be caused by pain, but may be due to anemia.
"Huh... The face is still a little yellow, is it jaundice? "
Lin Feng looked at the little boy carefully and found a new element "yellow-faced".
"Here, I'll give you a personal examination..."
The little boy was lying in bed,
If jaundice is suspected, that is, to examine the liver, spleen ...
A touch,
Something went wrong.
The liver is 3 cm below the right rib and 6 cm below the left rib of the spleen.
This liver and spleen are a little big!!
"Finger pain, anemia, hepatosplenomegaly..."
Lin Feng didn't come up with any clues,
"By the way, your husband has a family history there, what about you?"
"My side? No..."
"If you think about it, is there any..."
"Doctor Lin, there is really no such thing, if there is, I have long known..."
The young mother said.
Lin Feng nodded: "Okay, draw a blood and do two tests, namely "blood routine" and "hemoglobin electrophoresis test"..."
"Hemoglobin electrophoresis test": often used in the screening test of thalassemia, because thalassemia often has abnormal structure of hemoglobin, because abnormal hemoglobin has different molecular weight and electrical load, when doing hemoglobin electrophoresis, it will appear a special hemoglobin electrophoresis band, so that it is easy to find abnormal structure of hemoglobin, and then diagnose thalassemia.
Because thalassaemia does not come out until the next day,
"You guys don't go back first, and when the electrophoresis results come out tomorrow, you're coming back to me... I'll go back in the evening to check the information..."
"Doctor, I came from abroad, and I also heard that Dr. Lin is very powerful and can cure many incurable diseases, so I came from abroad with my children to find you specifically... So, instead of going to a hotel, why not spend a night in the hospital? "
In the hospital, much cheaper than the hotel.
Lin Feng thought for a while: "Okay, I'll admit you to the hospital..."
......
An hour later,
The results of the examination are out.
Blood routine report: confirm anemia!
......
The next day,
Lin Feng was in the consultation room, when he diagnosed 20 patients in the morning,
The young mother came with the little boy with the results of "electrophoresis".
"Doctor Lin, take a look..."
Lin Feng received the "electrophoresis" report.
· Hb-A2 (hemoglobin A2) 5.6% (3.5%, consistent with thalassaemia)
Therefore, it can be determined that the little boy is thalassasemia.
But
Lin Feng looked at the other values:
· Hb-F (fetal hemoglobin) 29.9%
· Hb-A (hemoglobin A); 68%（96.5%——97.5%)）
Lin Feng frowned.
Wrong!!
HB-F (fetal hemoglobin), how can there be so many?
It is produced in the sixth week of the fetus, which is when the mother is pregnant.
And after birth, it remains at a high level until the baby is about 2~4 months old. Levels usually decrease gradually within the first year and reach adult levels (less than 1% of total hemoglobin).
And the little boy in front of him is in elementary school!
So
Very unreasonable!
And
How can there be so little Hb-A (hemoglobin A)?
Its normal proportion is 96.5%-97.5%, and the result is only 68% for young boys.
Extremely low!!
This is not something that "thalassemia" can explain.
"Isn't it just 'thalassemia'?"
At this time,
Lin Feng thought of a disease:
"Sickle cell anemia"?
Sickle: Generally, cells are round, and sickle cells are the same as sickles.
If there are more sickle cells, there will naturally be fewer red blood cells, and it will naturally become anemia.
It is also a dominant genetic disease, similar to thalassaemia.
It has a characteristic that because its shape is not 'round' enough, it is easy to stagnate in the microcapillaries, causing blockage of blood vessels and leading to dysfunction of affected tissues and organs.
Its symptoms are:
If a large amount of blood is trapped in the liver and spleen, progressive enlargement of the liver and spleen will occur and hypovolemic shock will occur.
Stasis that causes chest and/or abdominal pain, hematuria, etc., is called a painful crisis, which can recur during the course of the disease.
Stagnation, which can cause swelling, congestion and pain in the joints of the hands and feet, called hand-foot syndrome.
This last one just fits the little boy's finger pain and repeated attacks!