stjorthotic Chapter 441
Chapter 441
Chapter 441
Lin Feng looked at the little boy in front of him.
· Finger pain,
·And it has been painful from time to time for many years!
What disease did the first thought come to mind?
That’s right!
Rheumatism! !
Think about the old man’s rheumatism, isn’t it just a pain from time to time?
Don’t think that rheumatism is a disease of the elderly, and children also have rheumatism.
E.g:
·Psoriatic juvenile idiopathic arthritis…
·Juvenile idiopathic arthritis…
Lin Feng looked at the child’s mother.
“The child has been sick for so many years, should he have been seen in the hospital?”
“Have.”
“Is there a medical record? Did you bring it?”
“Brought it……”
Then,
The little boy’s mother took out a small book from her handbag.
The cases are neatly organized and carefully.
Lin Feng was full of good feelings at once, and he was most afraid of the patients with messy medical records.
Turned it over,
Then I found that the “Rheumatism Immune Complete Set” had been checked.
All suggest negative.
In other words, rheumatism is ruled out.
“Is it possible to have gout?”
Lin Feng thought for a while and found it impossible. Although children can also cause gout due to dietary problems, most of the gout areas first start on the knees, 103 elbows, etc. The little boy in front of him only has finger pain? ?
“I’ll ask again, is it only the finger pain?”
“And toe pain…”
“Are there big joints like elbows and knees?”
“No, I haven’t tried…”
Young mother directly denied it.
Lin Feng thought for a while and ruled out gout temporarily.
“What medicine have you taken before? Is it effective?”
When it comes to this, the young mother feels a bit resentful.
“Every time the doctor prescribes a lot of medicines, it turns out that the medicines were useless later. After a few days, the pain disappeared and a lot of money was wasted… Dr. Lin, when the medicine is prescribed, please prescribe some cheap medicines. , My family is very poor and it is difficult for children to go to school…”
The young mother said with a little shame.
Lin Feng nodded: “Okay…”
There are indeed many medicines with similar effects, and the price difference will be very big, some are a few cents, and some are directly hundreds of dollars… Many doctors like to prescribe expensive medicines, and many patients are disgusted by them. .
Next,
Lin Feng asked some questions.
Did not ask anything.
allergy?
I took a closer look at the little boy’s fingers, and I couldn’t see any allergies such as hives… I couldn’t see it.
Lin Feng: “Is there any medical history? And family history…(aicd)…”
Young mother: “Yes, my husband has thalassemia… Then the doctor later diagnosed my son with thalassemia…”
Thalassemia,
This is a checkup to be done when the mother is pregnant. Putting it into the pregnancy checkup indicates that it is a very troublesome disease.
It is caused by anemia or pathological conditions caused by the lack or insufficient synthesis of one or more globin chains in hemoglobin due to inherited genetic defects. (Genetic inheritance)
If you say so,
The pale boy in front of him may not be caused by pain, but may be due to anemia.
“Huh… his face is still a bit yellow, is it jaundice?”
Lin Feng looked at the little boy carefully and discovered a new element “yellow face”.
“Come on, I will do a personality check for you…”
Little boy lying on the bed,
If jaundice is suspected, check the liver and spleen…
A touch,
Figured out the problem.
The liver is 3 cm below the right rib, and the spleen is 6 cm below the left rib.
This liver and spleen are a bit bigger! !
“Finger pain, anemia, liver and spleen enlargement…”
Lin Feng didn’t think of any clues.
“By the way, your husband has a family history, what about you?”
“My side? Nothing…”
“Think about it carefully, is there any…”
“Dr. Lin, there is really no such thing. If there is, I’ve known it a long time ago…”
Said the young mother.
Lin Feng nodded: “Alright, take a blood and do two tests, namely “blood routine” and “hemoglobin electrophoresis test”…”
“Hemoglobin electrophoresis test”: It is often used in the screening test of thalassemia, because thalassemia often has abnormal hemoglobin. Because abnormal hemoglobin has different molecular weight and electrical load, when doing hemoglobin electrophoresis, it will have a special The hemoglobin electrophoresis band, so that it is easy to find abnormal structure of hemoglobin, and then diagnose thalassemia.
Because the thalassaemia will not produce results until the next day,
“Why don’t you go back first, wait until the result of the electrophoresis comes out tomorrow, and come back to look for me… I will go back to check some information in the evening…”
“Doctor, I’m from another place, and I heard that Dr. Lin is very good at you and can treat many intractable diseases, so I brought my child from other places to look for you specially… So, instead of going to a hotel, or staying in a hospital Night?”
In the hospital, it is much cheaper than the hotel.
Lin Feng thought for a while: “Okay, I will handle the admission for you…”
…
after an hour,
The result of the check is out.
·Blood routine report: confirm anemia!
…
the next day,
Lin Feng was in the clinic and diagnosed 20 patients in the morning,
The young mother took the little boy and came with the result of “electrophoresis”.
“Doctor Lin, take a look…”
Lin Feng received the “Electrophoresis” report.
·Hb-A2 (hemoglobin A2) 5.6% (3.5%, in line with the thalassemia value)
Therefore, it can be determined that the little boy is thalassemia.
but,
Lin Feng looked at the other values:
·Hb-F (fetal hemoglobin) 29.9%
·Hb-A (hemoglobin A); 68% (96.5%—97.5%))
Lin Feng frowned.
Something’s wrong! !
Hb-F (fetal hemoglobin), how can there be so much?
It is a fetus, that is, when the mother is pregnant, in the sixth week.
And maintain a high level after birth, until the baby is about 2 to 4 months old. Usually the level gradually decreases within the first year and reaches adult levels (less than 1% of total hemoglobin).
And the little boy in front of him is in elementary school!
so,
Very unreasonable!
and,
How can there be so little Hb-A (hemoglobin A)?
Its normal proportion is 96.5%-97.5%. As a result, it is only 68% for little boys.
Very low! !
This is not what “thalassemia” can explain.
“Isn’t it just “Thalassaemia”?”
At this moment,
Lin Feng thought of a disease:
“Sickle cell anemia”?
Sickle-shaped: Normal cells are round, and sickle-shaped cells are the same as sickle.
If there are more sickle cells, there will naturally be fewer red blood cells, and it will naturally become anemia.
It is also a dominant genetic disease, similar to thalassaemia.
It has a characteristic, because its shape is not’round’ enough, so it is easy to stagnate in the tiny capillaries, causing vascular blockage, and leading to dysfunction of the affected tissues and organs.
Its symptoms are:
·If a large amount of blood remains in the liver and spleen, progressive enlargement of the liver and spleen will occur and hypovolemic shock will occur.
· Stasis causes chest pain and/or abdominal pain, hematuria, etc. This is called a pain crisis, which can occur repeatedly during the course of the disease.
· Stasis can cause swelling, congestion, and pain in the hand-foot joints, which is called hand-foot syndrome.
This last one happened to fit the little boy’s finger pain, which happened repeatedly! .