fever
I believe many people have experienced it
Many times it is caused by a cold
No big deal
But if the high fever has not subsided
It may be that the body is issuing a warning
You must pay attention to it
Mr. Wu (pseudonym), 38
The fever does not go away for several days
As soon as I entered the hospital, I was diagnosed with leukemia
When preparing to do chemotherapy
He was transferred to the Department of Hematology of the First Affiliated Hospital of Zhejiang University School of Medicine
Experts found
This is a special form of leukemia
Fortunately, I didn't do chemotherapy
Because treatment has another doorway
What's going on?
The man with high fever and fatigue was diagnosed with leukemia for three days
Almost used the wrong treatment plan
Mr. Wu, 38, is usually strong and strong, but last month, he suddenly felt weak and had a high fever that did not go away to 39 ° C. During the special period, he immediately went to the hospital for nucleic acid testing, and the test results were negative many times, so why did he eat anti-fever drugs with high fever or could not retreat? For this reason, he walked into the emergency department of a third-class hospital in Hangzhou late at night.
After three days of infusion treatment in the emergency room, Mr. Wu still had a high fever. After blood tests, Mr. Wu was diagnosed with acute leukemia by the hospital and was ready to be admitted to the hospital for chemotherapy. However, Mr. Wu heard that the hematology department of the First Hospital of Zhejiang University ranked fifth in the country, and he immediately rushed to the Hematology Department of the First Hospital of Zhejiang University to seek medical treatment.
Zhou Xinping, deputy chief physician of the Department of Hematology, received Mr. Wu and immediately admitted him to the hospital. "Is the mouth bleeding all the time?" Deputy Chief Physician Zhou Xinping and Zhu Li's attending physician found that Mr. Wu had large blood bubbles in his mouth during the rounds, and Dr. Zhu raised his vigilance when he saw that Mr. Wu's mouth was full of blood bubbles, and although Mr. Wu's platelets were only one-third of normal people, this value would not cause bleeding in the mouth all the time. "Have you ever worn a bone?" Mr. Wu immediately took out the bone piercing report he had done before, which read, "Consider acute myeloid leukemia." "Your bleeding symptoms are obvious and you need to be alert to acute promyelocytic leukemia, which is M3. I recommend that you do bone puncture and genetic testing again. The two doctors made a decision.
Bold and careful judgment
Save a patient's life
Acute promyelocytic leukemia, also known as M3, is a kind of acute myeloid leukemia, which is different from other leukemias is manifested by abnormal promyelocytosis, and the morphological characteristics of promyelocytosis are granules, so there will be many particles on the general acute promyelocytic leukemia bone puncture report.
What makes the hematologist frown is that acute promyelocytic leukemia has the characteristics of rapid onset, rapid change and bleeding, so when he saw a large amount of bleeding in Mr. Wu's mouth, he was vigilant. Moreover, in the clinic, the cerebral hemorrhage in patients with such leukemia is the most common and fatal. If Mr. Wu suffers from acute promyelocytic leukemia, but has been treated as a common leukemia in chemotherapy, he is likely to have cerebral hemorrhage in a life-threatening situation. Because promyelocytes are rich in procoagulants and fibrinolytic active substances, under the action of direct chemotherapy, procoagulocytes will release procoagulants and fibrinolytic active substances, resulting in serious abnormal coagulation function, and then bleeding symptoms, and severe patients will also have cerebral hemorrhage.
"Treat with tretinoin first!" At the same time, send the bone marrow smear to the bone marrow chamber and report it as soon as possible! "Tong Hongyan, chief physician, immediately made a decision after listening to the report on the condition, and decided to use the treatment plan specifically for acute promyelocytic leukemia - retinoin before the bone puncture report and the genetic test report came out - retinoin, which is a special drug for acute promyelocytic leukemia, which can induce the differentiation of such leukemia cells, and early use can reduce mortality in time, and the side effects are very small, and the advantages outweigh the disadvantages.
"Consider acute promyelocytic leukemia." Two hours after Mr. Wu used the retinoin treatment plan, Li Jianhu, the technician in charge of the bone marrow room, called. "Acute promyelocytosis is characterized by rich particles, the bone marrow image particles of this patient are not obvious, the cell morphology is not typical, and it does require a lot of experience in diagnosis." Li Jianhu still made a clear diagnosis.
"The treatment of M3 is to be accurate, early and fast! This patient took only three hours from reception to treatment with tretinoin, which is Zhejiang Yi speed! Fortunately, this patient was treated with tretinoin in time, which greatly reduced the risk of cerebral hemorrhage. Tong Hongyan, chief physician, said that the disease relies solely on chemotherapy for early mortality and high recurrence rate of patients, and the overall survival is poor. At present, the combination of tretinoin and arsenic has become the preferred regimen for the disease, and the cure rate has reached more than 90%. Therefore, once acute promyelocytic leukemia is suspected, treatment should be immediately treated with all-trans tretinoin, which can differentiate promyelocytes and reduce the risk of early hemorrhagic death.
A few days later, Mr. Wu's PML/RARA fusion gene test report confirmed that he had acute promyelocytic leukemia. Fortunately, this type of leukemia is the most prognostic leukemia, with a cure rate of 99%.
4 patients with 3 obese
This type of leukemia prefers fat people?
"Acute promyelocytic leukemia is generally fatter." Chief physician Tong Hongyan said that the proportion of obesity in such leukemia patients she has been exposed to clinically is relatively high, and Mr. Wu is also an obese person. In fact, clinical experience and international studies have long found that the proportion of obese, overweight or dyslipidemia patients in patients with acute promyelocytic leukemia exceeds that of other types of leukemia. Professor Hong hu, the head of the Department of Hematology, said that tumor cells need nutrients to grow in the body, and high fat is a fertile "growth soil" for tumor cells, which may promote the growth of tumor cells, so for patients with blood diseases, the impact of high blood lipids and high fat on diseases is a truth. In addition, some studies have found that obesity and high blood lipids are a sign of poor prognosis in tumor patients, so clarifying the relationship between hyperlipidemia and acute promyelocytic leukemia is also of considerable positive significance for treatment.
Is there a treatment that can treat acute promyelocytic leukemia while maintaining normal lipid levels? Professor Zhao Honghu's research team proposed a small-scale combination of ATRA/As2O3 and lipid-lowering drugs, and the results showed that this scheme can better improve the patient's abnormal lipid metabolism, thus providing a new treatment strategy and theoretical basis for the treatment of acute promyelocytic leukemia. It is believed that in the near future, more patients like Mr. Wu can benefit from the continuous improvement of research results for clinical diagnosis and treatment.
This article is the original of the First Hospital of Zhejiang University