bookpower Chapter 624
Chapter 624
「624」
"Fetomaternal Transfusion Syndrome"
It's a very common thing.
50%~75% probability.
That is to say, 50%~75% of pregnant women will have fetal blood transfusion to pregnant women.
The amount of blood transfused is usually about 0.01~0.1ml.
It's irrelevant, so no one will pay attention.
But!
There are also very special ones.
For some babies, the transfusion volume of the fetomother reaches more than 30ml.
Very rare.
But not for nothing.
And the little baby in front of him is likely to have "fetal mother blood transfusion syndrome".
So
A "KB test" is required.
The so-called "KB test" principle is: fetal blood and maternal fetal blood are different. Fetal hemoglobin has an antacid effect in acidic eluate, while maternal-fetal blood does not.
Therefore, a part of the mother's blood can be drawn and then analyzed: mixed = fetal blood? %+ maternal blood? %.
As long as the fetal blood content is too high, it must be "fetal maternal transfusion syndrome".
......
"Draw blood, do a "KB" test..."
Lin Feng ordered.
soon
A nurse with 10 years of experience in blood collection takes blood from the baby.
To explain, it is more difficult for the baby to collect blood, because the baby's veins are relatively deep, the blood vessels are thin, and the difficulty is particularly large, and the general nurse still can't get it.
After blood collection,
Just send it to "KB".
"I'll go back first, there are still many patients to be busy, just call me after the 'KB' results come out."
Lin Feng said to the other doctors.
"Thank you, Dr. Lin."
"Dr. Lin is just amazing."
"It doesn't seem like Dr. Lin won't."
Everyone expressed their admiration.
Lin Feng turned around and left the obstetrics and gynecology department.
......
In the afternoon,
Lin Feng is diagnosing a patient,
The nurse stood up and told Lin Feng:
"Dr. Lin, just now the obstetrics and gynecology department called and said that the baby's KB experiment has come out."
"How's it going?"
"Positive."
Positive, meaning the test result, confirms the "fetal mother transfusion syndrome".
"Dr. Lin, the obstetrics and gynecology department is waiting for your call..."
"Okay."
Lin Feng told the patient to wait first, then came to the nurse's station and picked up the phone.
Talk to the obstetrician and gynaecology.
"What is the content of fetal blood as a result of the test?"
"Dr. Lin, the result is that the mother's peripheral blood smear contains 3% fetal red blood cells."
"3% yes, then you can calculate the baby's blood loss..."
Lin Feng said to the nurse:
"Pen, paper, give me a little..."
The nurse quickly took a pen and paper to Lin Feng.
"First determine several normal values: the average blood volume of a pregnant woman at term pregnancy is 75 ml/kg; The average fetal-placental blood volume at term is 120 ml/kg. "
"Our first step: estimate the mother's total blood volume: if the mother weighs 80 kg and the hematocrit is 35%, then her total blood volume is:"
"80 (maternal weight) × 0.35 (hematocrit) ×75ml/kg = 2100ml."
Then step two: estimate your baby's blood volume:"
"The weight of the baby is 3110g, according to the general situation, the hematocrit of red blood cells before the birth of the baby is 45%, then the fetal-placental red blood cell volume is estimated to be: 3.1×0.45× 120ml/kg=167ml..."
"Finally, the third step is to estimate the amount of blood that the fetus enters the mother's blood circulation: the peripheral blood smear contains 3% of fetal red blood cells, then the estimated total amount of fetal blood entering the mother's circulation is: 2100ml×0.03=63ml..."
Lin Feng explained to the doctor in the obstetrics and gynecology department over there,
Calculate on paper while in hand ...
Final result:
The baby should have 167ml of blood all over the body,
Of this, 63ml returned to the mother, and the lost blood accounted for 37% of her own blood volume.
Such a terrifying amount of blood loss, of course, is very serious!
So
The skin will be so pale.
The next treatment does not need to be taught by Lin Feng.
Blood transfusion expansion
Symptomatic treatment
It is estimated that the baby's mother will be very confused when she knows this result.
He actually snatched the baby's blood?
(Conclusion: The lack of specificity and low incidence of prenatal manifestations of FHM make it difficult to make a prenatal diagnosis, and FMH has been reported to account for 5% of fetal deaths in utero.) ）
Lin Feng hung up the phone,
Return to the ward.
That Jiang Yue has been watching from the sidelines, and no one is chatting with her, which is very boring.
She was a little unconvinced by Lin Feng's popularity.
This "fetal mother blood transfusion syndrome", she had encountered it before in the lighthouse country, some of the content she still remembered, although not as powerful as Lin Feng, but somewhat understood. It's a pity that no one asked her, and she can't run to show off herself - I will too.
......
......
The next patient.
A mom with a 9-year-old boy.
"Doctor Lin, my son, I don't know what the reason is, he is always inattentive in his studies..."
Mom's face was worried.
“.................."
Lin Feng sweated furiously.
If you don't pay attention to study, the doctor is blind.
It is estimated that in the future, if Lin Feng has children, he will also be blind because the children cannot go to high school and college.
However, he cannot say it to his face.
"Apart from inattentiveness, are there any symptoms?"
The mother spoke quickly: "The child has always been inattentive in recent times, "deserted" in class, and said that he was a little dizzy when asked, but I didn't have a cold or a fever when I looked at it, so we didn't pay attention at first!" "
"But since last week, my son began to have intermittent abdominal pain and fatigue, and the symptoms of headache were also worsening, but there was no cold or fever, and I didn't pay attention, but the day before yesterday, the child began to vomit..."
Vomiting?
Lin Feng began to pay attention now.
Start the analysis:
For such a long time, and still running at school and at home, it should not be food poisoning.
There is no cold or fever, the duration is so long, most of the bacteria, viral infections can be eliminated.
"I'll check him up..."
Physical examination......
Press the stomach... It doesn't hurt...
Mental state, very vigorous, nothing wrong ...
But not 30 seconds.
The boy was impatient and began to struggle.
Reluctance to do tests.
Still looking around, in addition, it seems that he is a little fierce to Lin Feng, and glared at Lin Feng a few times.
"His face was a little pale... Is it usually so white? "
"Huh? Let me see...... Hey, it's a little white..."
Lin Feng groaned.
"Pale? Is it anemia? "
However, even if it is anemia, it is not the root cause, it should be a complication.
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PS: One change today, I'll cheer tomorrow.
。。。