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Preface
PrefaceBlood routine is a very important examination in clinical examination and has very important clinical significance.
Many of the specific indicators are very commonly used sensitive indicators, which are very sensitive to many pathological changes in the body
.
For example, platelets play an important role in clinical diagnosis and judgment of coagulation function
Case history
Case historyWhen I was doing blood routine tests recently, I found that the fluctuation of platelets in one patient far exceeded the normal range, from 87×10^9/L to 251×10^9/L, with a fluctuation rate of 18.
9%
.
case analysis
case analysisThe platelet quality control was under control that day, and the patient had not received platelet transfusion recently, so what is going on?
Figure 1 A screenshot of the raw data of the patient's blood routine test that day
Figure 1 Screenshot of the raw data of the routine blood test of the patient on the same day Figure 1 Screenshot of the raw data of the routine blood test of the patient on the same dayCould it be that the nurse took the wrong blood? The author contacted the clinic and took another tube of blood for the patient.
The platelet count was still around 250×10^9/L
.
Could it be that there are small red blood cells or red blood cell fragments in the patient's blood, and the instrument mistakenly identified them as platelets, so the author checked the red blood cell and platelet histogram and there was no abnormality
.
In addition, the author also pushed the stain to observe with a microscope, and there were no red blood cell fragments and small red blood cells under the microscope
Figure 2 The stained microscope image of the patient's blood sample on that day
Figure 2 The stained microscope image of the routine blood specimen of the patient on that day Figure 2 The stained microscope image of the routine blood specimen of the patient on the dayTherefore, the author communicated with clinicians
.
The patient's medical history is as follows:
After consulting the information, I learned that high blood pressure, insulin injections and oral betaloc will not affect the number of platelets
.
In addition, the patient received Plavix anti-platelet therapy a few days after admission.
So the author checked the blood routine history records and hospitalization records of the patient since he was admitted to the hospital, and after careful comparison and thinking, he found that the platelets increased every time the patient had a fever, and the sputum culture showed fungal spores
.
After antipyretic and anti-infective treatment, platelets will decrease again
Figure 3 Platelet historical data since the patient was admitted to the hospital
Figure 3 Platelet historical data since the patient was admitted to the hospital Figure 3 Platelet historical data since the patient was admitted to the hospitalFigure 4 The patient's sputum culture report, showing fungal spores
Figure 4 A report of a patient’s sputum culture showing fungal spores .Figure 4 A report of the patient’s sputum culture showing fungal spores.
In order to confirm this hypothesis, the author checked the relevant literature and found that fever does cause the platelet count in the body to increase.
The root cause is that thrombopoietin TPO in the body of fever-infected patients will increase greatly, which promotes the proliferation, production and release of megakaryocytes.
, Which in turn causes increased platelets
.
Summary
SummaryIn summary, the author believes that when dealing with daily work, especially when the patient's test results show large fluctuations, close communication with the clinic should be done
.
At the same time, inspectors also need to constantly absorb new knowledge, new ideas, and master new technologies, so that they can more keenly discover problems in their daily work, and put forward their own views and opinions when communicating with the clinic
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