Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

The family member said that his face was red and his neck was thick, and the surrounding patients and family members felt his anger.

At this time, Lin Yi came over. He also understood the family's mood very well, so he said in a gentle tone:

"Family, please don't worry. I think the biggest problem with your son may not be hemorrhoids, but a rare genetic disease."

The family members gave Lin Yi a blank look and said angrily:

"Who are you! The experienced doctor just now couldn't cure it, but you can still cure it?!"

Lin Yi was not angry, and continued to ask:

"Did your son often get black and blue when bumped and bumped, and his gums often bleed when he brushed his teeth?"

The family member raised his head and glanced at Lin Yi: "No! My son has been healthy since he was a child, and this has never happened before!"

"Huh?" Lin Yi was slightly taken aback.

No, if it is a blood clotting gene defect, there will be various possibilities of bleeding from birth.

Bumps and bleeding gums are just minor issues.

It is very likely that even if the amount of bleeding is slightly larger, it cannot be stopped, and everyone will die.

But this person...how could there be no such situation?

Could it be that Lin Yi made a mistake in his judgment this time?

On the side, the attending doctor gently pulled the corner of La Linyi's clothes and whispered:
"I have already asked this question, and the family members have ruled out the possibility of inheriting hemophilia from their ancestors."

When listening to Lin Yi's questioning, the attending doctor already knew what Lin Yi was suspicious of.

He also wondered whether the patient had hemophilia.

I also asked the family members specifically, and the family members said that no one in the family had ever had this disease.

The whole family is healthy.

It was also the first time his son entered the hospital for this kind of operation.

It was also the first time that the bleeding did not stop.

This answer put him off.

The puzzled expression was exactly the same as Lin Yi's now.

Could it be that Lin Yi made a wrong diagnosis?

Isn't this man hemophiliac?

So what's the situation?

The family members scolded for a long time outside.

When Lin Yi and the doctor in charge entered the emergency room, they saw that there was not much blood in the patient's drainage bag, which was still more than 20 milliliters.

Fortunately, the amount of bleeding is not large.

Lin Yi looked at the intestinal tract, and there was not much bleeding inside.

But the problem still needs to be resolved as soon as possible.

Uneven will suddenly bleed.

Looking at the patient on the hospital bed, Lin Yi said to the attending doctor:

"Then have you done genetic testing for blood clotting?"

The doctor in charge shook his head: "No, I planned to observe it overnight. If the bleeding stops tonight, I won't do it. If it's still bleeding, I'll check it out tomorrow morning."

Lin Yi let out a breath and said:
"My suggestion is to investigate immediately! This patient can't wait, who can bear the bleeding several times?

It is true that there is only more than 20 milliliters of bleeding in the drainage bag, but if it is not enough, it will cause heavy bleeding later.

So quickly draw blood and let the laboratory check to see if it is a blood clotting gene defect! "

Lin Yi spoke in a resounding tone.

The attending doctor was taken aback for a while.

"Check now?" The attending doctor asked in a daze.

"Yes, check now, check quickly.

Although the family members said that there had never been any unexplained bleeding, we, as doctors, had to be cautious.

What if he had hemophilia! "

"Okay, I'll give the doctor's order to ask the nurse to draw blood."

The results of genetic testing usually take four to five days to come out.

During this period, we can only control the patient as much as possible so that the wound does not bleed.

The attending doctor whispered while giving the doctor's order:

"I really wonder, if it is really hemophilia, why has this person never had unexplained bleeding before?

Bleeding when brushing your teeth should be very common.

But this patient has always been healthy and had no problems before admission. Hey... Strange! "

next second!
Suddenly he looked up again!

"By the way! Could it be that this person...is a subclinical coagulation gene defect?!"

Coagulation gene defects are also typed.

Severe, moderate, mild and subclinical.

Take hemophilia A, for example.

Severe hemophilia A has the least amount of FVIII gene factor, at least less than 0.01U/ml (100%).

In contrast, severe patients have the most obvious symptoms, such as spontaneous and repeated bleeding, internal organs, joints, skin, etc., and the mortality rate is very high.

The symptoms of the medium type are lighter than those of the severe type, and there will be spontaneous bleeding, but most of them are bleeding heavily after trauma.

Mild patients basically do not bleed spontaneously, but only after trauma.

The subclinical type is the mildest type.

These patients have no obvious symptoms since birth, neither spontaneous bleeding nor teeth brushing bleeding.

They only bleed abnormally after surgery or major trauma.

Such patients are the most difficult to detect blood clotting gene defects.

Just like this patient.

Never had any symptoms of this hemophilia and have always been healthy.

There is no problem with the basic examination of admission.

So it is difficult for doctors to take this point into consideration.

Unexpectedly, he came to the hospital to cut a small hemorrhoid, which led to him being in the operating room three times.

This situation is too rare!
Thinking of this, the attending doctor also became excited!

After he ordered the nurse, he hurriedly said to Lin Yi:

"I guess it might be hemophilia, just the rarest subclinical form!
This type is the most difficult to be found, and it is also a relatively mild type.

But if the bleeding cannot be stopped, it will be life-threatening. "

Lin Yi turned his head, glanced at the excited attending doctor, and said calmly:
"That's why I asked you to check it quickly to see which type of coagulation factor is missing."

The attending doctor laughed twice.

Although the results haven't come out yet, Lin Yi's ability to think of this place as soon as he came here also shows that his brain is really spinning fast.

If it wasn't for Lin Yi's reminder, the attending doctor would not have expected to come here.

"Okay, then you guys are busy, I will get off work first. If you need anything later, you can come to me for help.

By the way, if this patient keeps bleeding, I suggest you take a gamble. "

The attending doctor frowned: "What do you mean?"

"Just bet that this patient has hemophilia, and transfuse the blood of FVIII and FIX together to see if it can stop the bleeding."

The attending doctor stared at Lin Yi in shock, and saw that Lin Yi finished speaking, and left the emergency department with his hands in his pockets.

He is almost starving right now, so he hastened to go out and eat something to fill his stomach.

Behind him, looking at Lin Yi's slightly tall and unrestrained back, the attending doctor couldn't help but said:

"Good guy, you can bet on this..."

Of course, the attending doctor said so.

But if the patient will continue to bleed, he will still do as Lin Yi said.

Because all methods have been tried before.

They went up and down, and all available methods including interventional hemostasis were used, but they still didn't work.

Then we can only consider rare diseases.

At that time, if the bleeding is really serious, the blood bank can only prepare this special blood for emergency treatment.

If it works, it means the bet is right.

If it doesn't work, then their doctors did their best.

Although they have bled several times since being hospitalized, they are still trying to find the cause and try to rescue them.

The patient was indeed admitted to the hospital to cut hemorrhoids and all this was caused.

But the essence is not because of poor hemorrhoid surgery, but the unexplained bleeding in the patient.

The attending doctor turned and went back to the office.

A doctor who was working overtime hurriedly told him:

"Dr. Liu called and asked you to quickly order a blood coagulation gene test. He said he will be at the hospital soon."

The attending doctor nodded calmly:
"I've already done it, and the nurses have taken the blood and sent it to the laboratory."

"That's good. I heard Dr. Liu's tone on the phone was quite anxious."

"It's okay. The amount of bleeding is not large and can be controlled. You guys should get off work as soon as you're done."

"Okay, I'll go right away."

…………

After a while, the doctor Liu came over.

He is in his 40s and is a senior emergency physician.

He didn't care so much and went straight to the emergency room. As soon as he came in, he looked in front of the hospital bed and saw that he was bleeding again.

But not much at the moment, about [-] milliliters.

"Doctor Liu, this is the result of CT and colonoscopy that just came out, and another mesenteric blood vessel ruptured and bleeds!"

Seeing Dr. Liu coming, the attending doctor immediately presented the examination he had just done.

Dr. Liu looked at it and asked:
"Is the blood clotting gene done?"

The attending doctor nodded: "It's been done, the one just now..."

Seeing the doctor in charge stammering, Doctor Liu turned to look at him and said:

"What happened just now? How can you stop talking halfway? Say something quickly!"

"Lin Yi came over just now, and he said that he suspected that this patient was hemophilia."

"He is here?"

"Yes, I invited him here. He came to the emergency room to have a look, and after looking through the medical records a few times, he suspected hemophilia.

He also forced me to do a blood coagulation gene test. I thought what he said was reasonable, so I agreed. "

"The blood coagulation gene test he asked you to do?"

"Ok!"

Dr. Liu pursed his lips, lowered his eyes slightly, not knowing what he was thinking.

Then he added:
"Has the blood been sent to the laboratory? Tell them that we are urgently investigating and let them get the results as soon as possible."

"Okay, I'll call the laboratory right away."

Doctor Liu immediately waved his hand again and said:
"Forget it, I'll go directly to the laboratory to urge them later."

As soon as the words fell, the patient's drainage bag suddenly changed color!
From light red to dark red!

And the flow rate in the drainage bag is also accelerated!
Immediately, Dr. Liu and the attending doctor secretly shouted that something is wrong!
Oops!

It's bleeding again!
Doctor Liu immediately ordered:

"Hurry up and notify the interventional department, saying that we are going to have an emergency operation in the emergency department!"

Bleeding started again, and Dr. Liu's first reaction was to block the bleeding vessel with another interventional hemostasis.

Because before the results of blood coagulation gene testing come out, only interventional surgery can really stop the bleeding.

Other medications are totally ineffective!

"it is good……"

The attending doctor just turned around to make a phone call, but suddenly turned back.

Seeing the doctor in charge, Dr. Liu stood still in place and shouted immediately:
"What are you doing standing here? Being a model? Hurry up and contact the operating room!"

The attending doctor pondered for a moment, then said:

"Doctor Liu, why don't we treat it according to hemophilia! If it will be sent for interventional surgery, it will be another blood vessel bleeding next time.

But if... If we treat hemophilia according to hemophilia, all the blood plasma needed by hemophilia A and B will be used for transfusion to patients.

That is to stop the bleeding in the true sense, so that the patient will not bleed again later. "

"What did you say?!"

Dr. Liu glanced up and down at the attending doctor.

This kid is usually naive, how come he suddenly became shrewd again?

Dead horse according to living horse medicine?
Take a gamble? ?

It seems that it is not impossible!

Since he still bleeds after all the methods have been tried, bleeding reappeared even after the interventional surgery.

Then this patient probably has to consider whether it is a rare coagulation disorder.

Now that you have already suspected this point, why don't you give it a try?
After hesitating for two seconds, Doctor Liu nodded and said:

"Okay, call the blood bank and ask them to bring over FVIII and FIX plasma! Two hundred milliliters each!
In addition, we still need to inform the Intervention Department again. If our blood transfusion still cannot be stopped, we still have to do another intervention. "

"it is good!"

The attending doctor immediately went out and called to make arrangements.

In the emergency room, with the help of nurses, Dr. Liu changed another piece of oil gauze to the patient to stop the bleeding.

The oil gauze in the anus was almost soaked in blood when it was taken out.

Looking at the situation, Dr. Liu already suspected hemophilia with an 80% probability in his mind.

Otherwise, the bleeding will not stop, and the medicine and intervention will not work.

That could only be a coagulation disorder.

Outside the emergency room, the family members were so angry that they wanted to hit someone, but fortunately the security guard stopped them.

He didn't sign the critical illness notice in the hands of the attending doctor either.

The doctor in charge had no choice but to not sign for the time being and wait for the rescue.

"Here comes the blood, you want two bags of FVIII and FIX, right?"

The nurse at the blood bank came to the emergency room with a bag of blood boxes and asked.

"That's right, give it to me!" The attending doctor hurriedly signed, and then walked to the emergency room with the blood.

Outside the door, the family members cried seeing the doctor's hasty pace while holding the blood.

A man in his late 60s was sitting on a chair, weeping silently, and said while crying:
"Son...you can't die, my son...your mother is gone, how can you live if you leave me alone..."

The security guard went over to comfort him, but was thrown away by him.

In the emergency room, the nurse hung the blood bags on the patient's left and right venous channels.

While infusing FVIII, which can treat type A, while infusing FIX, which can treat type B.

Looking at the pale yellow plasma slowly flowing into the patient's body, the attending doctor looked at Dr. Liu and said:
"The patient's father has always said that the patient has never experienced unexplained bleeding since childhood.

There is no gum bleeding caused by brushing teeth, and there is no bruise when you touch your body lightly.

All his problems appeared after he came to the hospital to cut a hemorrhoid.

So I infer that if the patient is really hemophilia, it should be the mildest subclinical type.

A unilateral dose of [-] ml can almost meet the subclinical needs for FVIII and FIX factors. "

Dr. Liu turned to look at the attending doctor with some surprise in his eyes.

What happened to the attending doctor today?

Usually in the department like a little transparent, not saying a word.

Why did you suddenly wake up tonight?

"Okay, the analysis is quite in place."