In danger of the blood routine reversal, 99% of people do not understand!

!---- a qualified inspector, in the face of difficult work problems, do not let go.should always adhere to the attitude of truth-seeking and truth-seeking, active thinking, positive evidence and clinical communication, from the actual clinical performance of patients to analyze.only through such repeated training can we continuously improve their clinical thinking ability, overcome a clinical problem.case after a night shift review of the blood routine, found a special report that a patient had two "reversals" between the results of the day (see below). The results of MCV and MCHC in thebefore and after report, as well as the proportion of neutral particles and lymphocytes, were reversed.case study MCV and MCHC are usually very stable, and the latest multicenter study mentions that these two indicators should be further retested when the results change twice in the week or after 5%.in addition, Zhang Shimin teacher of a case, is because of the attention of two blood routine results of MCV and MCHC changes, through analysis finally found that the specimen was forgotten to a few days after the result of delivery.but in this case the cause of blood transfusion is not considered first, and the query collection time also excludes the possibility of old specimens. What is the reason for the huge contrast betweenand back and forth? To find out why, I compared the red blood cell morphology of two specimens (shown below).it is not difficult to see from the two blood smears that the red blood cells are indeed significantly different, the noon specimen appeared more ratchet,serrated and spherical red blood cells, and the night specimen looked much more normal. diddraw the wrong blood? But intuitively it feels a bit too coincidental, and has indeed encountered such a contrast before, perhaps really the patient's own reasons? So I went to check the medical records, learned that the patient at 11 a.m. sudden heart attack, and even a cardiac arrest, but finally rescued back.continue to look at other results and found that the pH was only 6.653 with lactic acid in the blood gas analysis results of the patient's admission, indicating that severe lack of oxygen in the tissue caused acidosis.see the results, suddenly came to mind an idea, is the inner environment of the great changes caused by the change of red blood cells? In order to further verify my hypothesis, I searched the relevant literature, and really found something.page et al. , the lack of oxygen in the body will lead to the production of red blood cells ATP and also prototype coenzyme II synthesis reduction, erythromycin and membrane at-dependent enzyme protein structure and function of multiple abnormalities, intracellular acid poisoning, sodium potassium pump disorder, Ca2 plus overload and many other factors make red cell skeleton protein structure and function abnormal, leading to red cell malformation.and this distortion happens to be the appearance of ratchet-balling of red blood cells, that is, red blood cells lose double concave or single concave disc structure, blunt serrated protrusions are more obvious, cell appears distorted deformity, ratchet increase, and visible helmets, star, multi-angle, small spheres and even broken red cells (cracking cells) formation.article also used electro-mirror technology to study red blood cell morphology, as follows: It has to be said that our findings are very consistent with what is described, but such morphological changes can cause this change in blood routine? The answer is yes.because, as shown in this case, there are a lot of spherical red blood cells, which is due to the expansion of the volume of the primary red blood cells, the loss of the double concave disc structure.this, it will naturally cause volume determination to increase, resulting in an increase in the pressure level determination, as well as a decrease in the MCHC.But because this change is related to hypoxia and acidosis, when the patient's treatment improves the internal environment, the red blood cell morphology will return to normal.in addition, in follow-up follow-up, I found that the patient's next day blood routine MCV and MCHC rewind again, while the blood gas was found to have also appeared significant acidosis.in order to make everyone feel more intuitive, the results of the three times are summarized below.performance confirms that significant changes in the internal environment in critical and critical conditions affect red blood cell morphology and thus the results of the red blood cell index.let's look at the inversion of the neutrophil/lymphocyte ratio.should, logically speaking, have white blood cells and neutrophils elevated under stress conditions, but in fact the blood routine at noon is not like this.I think there are two reasons for this: first, the whole body hypoxia and severe inflammatory response, so that the white blood cells in the blood vessels wall, resulting in the circulation of white blood cells did not rise;well, the above is my personal interpretation of this blood routine results, I hope to have some inspiration and help for you.in general, I hope that we do not ignore changes in the erythrocytic index in our normal work, as they often reflect changes in red blood cell morphology and can provide important clues to the occurrence and development of some diseases.the end of the words I looked carefully, wearing thick lenses to carefully identify.i'm trying to learn, and i've struggled to explore in this vast ocean of medicine.it was not until many years later that I gradually discovered that the word "life" was hidden vaguely in these characters and graphics.Source: End of the !-- content presentation of the Medical Network -- !-- determine whether the login ends.