Horrible.

This is the first impression.

On the observation bed was a seven or eight-year-old boy with dense red rashes on his exposed face and neck.

It would be more appropriate to say that the rash has eyes and nose.

Open the quilt.

The boy had large and small bruises all over his body, which looked very oozing.

"Have you done a routine blood test?" Xu Qiu asked.

Signs in boys such as spontaneous skin and mucous membrane bleeding.

Ecchymoses may be intracutaneous or subcutaneous bleeding points.

It's just that - the density of this bleeding is a bit too high.

It's like a human skin map.

In this case, you must first be alert to thrombocytopenia!

Platelets are a component of blood whose main function is to stop bleeding.

A normal person's platelet count is between 100 and 300 units.

Once the platelet count is less than 10, it is life-threatening.

Platelet suspension must be transfused immediately to prevent intracranial hemorrhage.

"It was done, but we're still waiting for the results... We came from the community hospital..." the boy's mother said in a panic.

Xu Qiu: “Where are the medical records and examination reports?”

The boy's mother said: "The community said there is no need to transfer to another hospital, but my baby is like this and we are so scared! So we didn't even go through the discharge procedures and sent him here directly!"

Xu Qiu understood.

No wonder there are no medical records or examination reports, it turns out they were slipped out.

He glanced at the boy.

With such severe spontaneous bleeding, he expected that the blood routine would not be optimistic, so he asked the nurse to prepare platelet suspension and various rehydration measures.

Here, Xu Qiu asked about his condition.

"How long have you had these symptoms?"

"..."

"Do you have any fatigue, fever, vomiting or diarrhea?"

"..."

"Have you taken any medicine?"

…

After the consultation, Xu Qiu gave the boy a detailed physical examination.

The liver and spleen were not enlarged by palpation.

There were no abnormalities on auscultation.

Xu Qiu frowned slightly and checked the boy's mouth again.

The family members were frightened.

There were a lot of purple-red and black mucosal lesions in the boy's mouth. At first glance, it looked like it was almost filled with various blood blisters.

"How could this happen? It doesn't seem to have happened before!"

"Doctor, please save my child!"

The family members panicked all of a sudden, and several elders stamped their feet anxiously, wishing these blood blisters would grow on themselves!

Xu Qiu called the laboratory department.

"Dr. Gu, there is a boy here in the emergency department. Please help me with emergency treatment."

"sure!"

Sure enough, five minutes later, the inspection report came out.

Xu Qiu quickly glanced at it.

White blood cells are normal.

Low red blood cells and hemoglobin, severe anemia.

The key is:

Platelets 9*10^9/l. (normal value: 100~300*10^9/l)

Such rare platelets mean that the patient's ability to stop bleeding is drastically reduced, and intracranial hemorrhage may occur at any time, leading to death.

"Rehydration."

"Transfuse platelet suspension."

Xu Qiu put down the checklist with a calm and calm voice.

The little nurse also breathed a sigh of relief and quickly followed the doctor's instructions.

Fortunately, Dr. Xu had predicted this in advance, otherwise it would have taken dozens of minutes to wait for the report from the laboratory department and then prepare the medicine!

"Go for a bone marrow examination. It's most likely ITP." Xu Qiu said.

itp, idiopathic thrombocytopenic purpura.

This is an autoimmune disease.

The clinical features are immune system abnormalities, which lead to thrombocytopenia.

The main manifestation is bleeding of skin and mucous membranes.

The most sinister sign is oral blood blisters - which means the patient is at high risk for intracranial bleeding.

When Xu Qiu saw extensive damage to the boy's oral mucosa, he already suspected severe ITP.

but,

The final diagnosis requires another bone marrow smear test.

…

For this examination, it usually takes three to seven days for the outpatient clinic to produce the results.

But the emergency room is much faster.

Especially when the doctor who wrote the order is named "Xu Qiu".

At around five o'clock in the afternoon, the boy's bone marrow examination results were printed out.

Increased megakaryocytes, maturity disorders, reduced nuclear lobulation, and imbalanced nuclear-cytoplasmic development...

Typical itp lab performance.

Xu Qiu looked at the examination form in silence for a while and understood why the community hospital said there was no need for referral.

"Prescribe dexamethasone, 1.5 mg intravenously. After symptoms subside, switch to oral prednisone."

After the doctor’s order is issued.

That night, the boy was hospitalized for treatment.

The family members spent the night worried.

The next day, the first ray of sunlight in the morning shone into the ward, and the boy's mother also woke up.

Her eyes were haggard, and she was about to touch her son's forehead, but she suddenly froze!

After just one night of treatment, most of the bruises on my son’s face were gone!

She quickly shook her husband awake and called the boy's grandparents to wait.

The family cried with joy as they watched the child's body gradually return to normal.

Xu Qiu originally expected that he might need to take dexamethasone for three days.

As a result, the boy was almost better on the third day, and his platelets gradually recovered and were out of the danger range.

The family was discharged from the hospital.

Before being discharged from the hospital, Xu Qiu's family members held her hands and shed tears.

"Wow, wow, I was scared to death. I thought my baby was going to die! I'm sorry, we shouldn't have questioned you at the time!"

"Yes, he is such a good doctor. I will give you a banner when we go back!"

“Thank you so much!”

The family members apologized and thanked Xu Qiu.
To be continued...