Free Web NovelChapter 573: Chapter 262: Elimination One by One, A Diagnosis from a Different Perspective
Through a complete blood count, it is basically confirmed that purpura is caused by thrombocytopenia, leading to subcutaneous bleeding in the patient.
We can now basically rule out the possibility of congenital blood disorders.
Then, the three common causes of acquired purpura are all worth considering.
Since the patient has thrombocytopenia, and allergic purpura generally does not accompany thrombocytopenia, we can preliminarily rule out allergic purpura.
That leaves drug-induced purpura and infectious purpura.
To determine which type of purpura it is, Li Jingsheng didn’t rush to request new tests but started by examining thrombocytopenia to further analyze.
At this moment, it’s truly a case of realizing there’s not enough knowledge when it is needed.
The textbooks medical students study in school are certainly not enough.
Li Jingsheng likes to read books in his spare time and considers himself quite knowledgeable in medical science.
However, when faced with this kind of complex disease outside his expertise in the clinic, he feels a bit overwhelmed.
He wracked his brains, painstakingly recalling the common causes of thrombocytopenia.
Primary Immune Thrombocytopenia can be divided into acute and chronic types.
The acute type may present with severe spontaneous skin and mucosal bleeding tendency.
Platelet counts are usually less than 20 times 10 to the ninth power per liter.
It is most common in children.
This patient is nearly sixty years old, with the current platelet count around 80.
He preliminarily excludes the acute type.
Next is chronic immune thrombocytopenia, which occurs mostly in young individuals, with a higher incidence in females than males.
It usually manifests slowly, with platelet counts most commonly between 30 and 80.
However, in this disease, patients with platelet counts greater than 50 times 10 to the ninth power per liter often have no significant symptoms.
Therefore, there are discrepancies with this patient as well.
Li Jingsheng’s diagnosis did not hit a dead end at this point.
Thrombocytopenia is not limited to the primary type; there is also secondary thrombocytopenia.
He made efforts to recall the relevant medical knowledge about secondary thrombocytopenia.
Fortunately, he was promoted to deputy chief physician yesterday, and now, during diagnosis, it feels like divine intervention, as many long-forgotten medical knowledge pieces are awakened whenever he thinks of them.
The human brain is the most mysterious, with less than 10% developed.
Much of it is in a dormant state.
Moreover, brain cells have their own mechanism of renewal and replacement. Many memories gradually fade over time and need to be refreshed or awakened to become reinforced and consolidated.
This is also why memorable moments remain unforgettable, even after decades.
Because these vivid memories are often easily recalled multiple times.
But if boring knowledge is not used, it might remain abandoned in the memory vault for a long time.
And then slowly be forgotten over time.
With the promotion in his medical rank, Li Jingsheng felt that all the medical knowledge he had learned was being awakened. His memory seemed enhanced.
Moreover, during diagnosis, that sense of a broader perspective is more prominent.
Attending physicians’ diagnoses are generally confined to their area of expertise, occasionally touching on other subfields.
A deputy chief physician, however, possesses a strong overall view, understanding all nine systems of the human body and the three major circulations. Such physicians can often perform cross-disciplined diagnoses and learn from analogy.
"Secondary thrombocytopenia can be divided into drug-induced, infectious, immune, and hematological categories."
He successfully recalled the medical knowledge related to this category.
Drug-induced thrombocytopenia can be due to either suppression of bone marrow by drugs or immunological reasons.
If it is bone marrow suppression, it is often accompanied by anemia and leukopenia.
If it is immunological, it usually occurs after re-administration, generally presenting suddenly with platelet dysfunction.
For example, giant platelet syndrome, platelet asthenia, storage pool disease, etc.
These conditions are extremely rare.
He preliminarily excluded the possibility of immunological issues.
Then he recalled that the patient’s complete blood count showed a white blood cell count of about 21, whereas a normal count for adults should be between 4 and 10.
This is obviously a significant increase.
If it were bone marrow suppression, white blood cells should decrease, but why did they increase significantly instead?
At this diagnosis stage, he began to encounter difficulties.
Being chosen by the judging panel as a test case, the difficulty level is simply hellish.
Such a patient, if sent to an average top-tier hospital, could easily exhaust several ’experts’.
Li Jingsheng looked up at the doctors in the venue, and many had already given up in defeat.
It’s like asking a history major to defend an economics thesis; it is purely torturous.
Nobody likes being tortured.
Except for people like Li Jingsheng and Lian Tao, who are inherently passionate about delving into medicine and truly love it.
The majority of doctors chose the profession perhaps not out of passion at first, but merely because doctors earn well, enjoy good social status, and have job stability.
Later, through work, they gradually found treating and saving people brings a great sense of achievement and happiness, which led to their growing love for the field.
Li Jingsheng again stared at the tablet computer. The diagnosis had reached this point, and it was just one or two steps away from completion, so there was no reason to give up halfway.
He found it difficult; others found it difficult as well.
"Need to change perspective, not get stuck on this one factor of thrombocytopenia."
After Li Jingsheng’s diagnosis hit a roadblock, he immediately adjusted.
He changed his diagnostic direction.
