Same case, but with different results, who is changing?

For example, for a clinical laboratory like our general staff rotating night shift, we are most afraid of being alone on the night shift encountered is not the difficult problem of this professional group, this is not, tonight our beautiful "little white" was "lucky" hit, (Figure 1) is 21:52 emergency examination of a case of blood routine results, such an abnormal result, change is you alone on the night shift, is not the heart silly bottom? To see how our beauty "Little White" is done? Figure 1 The patient's blood routine results case after facing the clinical diagnosis of diabetes in the 67-year-old elderly male blood routine results, the beauty "Little White" first asked the emergency doctor whether the patient has been diagnosed with blood disease? When it was learned that the patient has no history of blood disease, 4 days ago in the hospital also tested on an empty stomach blood sugar, glycated hemoglobin, insulin, C peptide and urine analysis and other diabetes screening items, unfortunately did not do blood routine, only 4 days after the discovery of many legs without induced bruising, then push a blood tablet! Pushing tablets, dyeing steps for the "little white" or not a problem, because not long ago internship, 10 minutes kung fu dyeing, mirror next look, the number of plateroids is about 1-2 per oil mirror field of view, with the blood analyzer count results in line with, but white Cell morphology has puzzled her because these white blood cells are large, rich in plasma, irregular in nuclear shape, and have vaguely visible, different amounts of cytogenic granules (Figure 2), which is a real challenge for young people without professional hemocytomorphology training.
pictures of the patient's perulsion taken on a mobile phone know that they are abnormally shaped white blood cells, but what type and stage is it? Mononucle cells? Childish granulocytes? Silly indistinct, how to give a clinical report? What would you do if you were on duty? Can the white blood cells be classified until the next day by a full-time morphology teacher to report again? If so, will treatment be delayed? Fortunately, she is also more clever, immediately use the mobile phone to take pictures down to the undergraduate room WeChat group, please have not rested, morphological experience of other teachers to help.
Thin not, soon there is a master to help, 2 pictures, 8 minutes to complete, the original is unusually dangerous acute early granulocytic leukemia, so immediately the blood routine results audit released at the same time, the initiative to send a blood coating to the clinic Film report (Figure 3), and telephone to inform the emergency department on duty doctors, the severity of this leukemia and the urgency of timely diagnosis and treatment, the doctor listened to the advice of the inspection staff, taking into account the hospital ward building in the decoration, so immediately transferred patients to experienced hematology specialist hospital for treatment. figure
3 to the patient's weekly blood morphology report later learned that if the examination department does not give the doctor to make this call, the doctor will apply to the patient for infusion platea, other treatment may have to wait for the second day.
After January, the telephone follow-up patients, in the night transferred from our hospital to the hematology specialist hospital, timely received bone marrow puncture examination, and took appropriate treatment measures, its final diagnosis and the hospital form room teacher's judgment is consistent - acute early granulocytic leukemia, which is undoubtedly lucky for patients, patients can be treated in a timely manner is we are pleased.
The diagnosis of this case reminds me of a case seven years ago in which a 79-year-old elderly woman was also diagnosed with a lack of strength and multiple bruises without triggers, and came to see a doctor at night, with blood routine results showing WBC:8 7.37 x 109/L, PLT: 24 x 109/L (Figure 4), because the blood analyzer did not give a classification of white blood cells, just in time for non-pro-test professional team personnel on night shift, so push A blood smear was placed in the morphological room, and told the doctor to wait for the second day of the morphological room staff to report the results of white blood cell classification, only the blood routine results without white blood cell classification audit released, and so on the second day of the morphological room personnel will be the smear staining mirror after confirming that more than 90% of the cells under the mirror are abnormally early granulocytes (Figure 5), immediately contact the emergency doctor, but at this time the patient has appeared under the eye bleeding and consciousness disorders, although the final treatment.
Figure 4 Blood routine results of an elderly female M3 patient on January 3, 2014 Figure 5 January 2014 A case study of the outer blood of an elderly female M3 patient analyzed acute early granulocytic leukemia is a special type of acute myeloid leukemia, with specific fusion gene and chromosomal nucleotype changes, clinical manifestations are dangerous, rapid, rapid progress, and easy to cause death.
but this type of leukemia, if it can be treated in a timely and effective manner, is currently a type of acute leukemia can be fully cured.
so early detection, early treatment is particularly important.
can find abnormal early granulocytes from the outer blood smear is the key to diagnose the disease, clinical laboratories should find abnormal early granulocytes in the outer blood as a critical value project timely and accurate report to the clinic, only in this way, in order to provide the first and most valuable evidence for clinical diagnosis of the disease, for patients to win treatment opportunities, save patients' lives.
Conscular experience compared to 6 years apart 2 cases of leukemia, are old age, clinical symptoms, blood routine results, weekly blood cell morphology are very similar, come to the hospital at night, but the outcome is different, analysis of the reasons for 3 points: 1, with the development of medical testing technology, blood and body fluid cytomorphology diagnosis Value is gradually recognized, inspectors rely entirely on the ideological awareness of the instrument is changing, the technical level of inspectors continue to improve, 2, the development of information technology, so that people's communication is no longer subject to space, time constraints, communication is more convenient and smooth;
Tang Yufeng, Song Lijun Source: Test Medical Network !-- Content Display Ends -- !-- Determines whether the login ends.