01 离挂号结束还有一分钟的时候,电脑的排队系统又跳出一个患者的名字.刚挂上号的是个小伙子,他手上拿着厚厚一沓病历走进来,说是替他表姐来咨询的.我问他怎么不早点来,小伙子说他刚赶到上海,差点就没办法赶上预约的号. 大老远从河南赶到上海,只为了替表姐咨询一下专家的意见,姐弟情深让我心里一动.

1 首先要明确什么是贫血.在血常规中,红细胞(RBC)减少,血红蛋白(Hb)减少或血细胞比容(HCT)减少,都称为贫血. 2 如果有头晕、乏力、心悸、胸闷、记忆力减退、胃口莫名减退、脸色苍白、皮肤粗糙、脱发、指甲失去光泽等症状,去验个血常规吧.

题目很奇怪,是吗?因为"是不是自己的病人"与"想念"之间,没有必然的逻辑性.但我还是想用这个题目. 今年是建党100周年,也是我入党36周年.我非常想念我的中学母校校长、党总支书记陈德生老师,那个像慈父一样言传身教地指引着我从懵懂少年成长为具有崇高理想和坚定信念的青年布尔什维克的人.

Importance It remains uncertain whether vitamin C routinely used with oral iron supplements is essential for patients with iron deficiency anemia (IDA). Objective To compare the equivalence and assess the safety of oral iron supplements plus vitamin C or oral iron supplements alone in patients with IDA. Design, Setting, and Participants This single-center, open-label, equivalence randomized clinical trial was conducted from January 1, 2016, to December 30, 2017, in Huashan Hospital, Fudan University. Adult patients with newly diagnosed IDA were enrolled. Participants were randomly assigned (1:1) to the oral iron supplements plus vitamin C group or the oral iron supplements-only group. Data analysis was performed from March to December 2018. Interventions Patients were randomized to receive a 100-mg oral iron tablet plus 200 mg of vitamin C or a 100-mg iron tablet alone every 8 hours daily for 3 months. Main Outcomes and Measures The primary outcome was the change in hemoglobin level from baseline to 2 weeks of treatment, and an equivalence margin of 1 g/dL in hemoglobin was chosen for the demonstration of comparable efficacy. Secondary outcomes included the change in the reticulocyte percentage after 2 weeks of treatment, the increase in hemoglobin level after 4 weeks of treatment, the increase in serum ferritin level after 8 weeks of treatment, and adverse events. Results Among the 440 randomized patients (220 each in the oral iron supplements plus vitamin C group and iron-only group; 426 women [96.8%]; mean [SD] age, 38.3 [11.7] years), all were assessed for the primary outcome, and 432 (98.2%) completed the trial. From baseline to the 2-week follow-up, the mean (SD) change in hemoglobin level was 2.00 (1.08) g/dL in the oral iron supplements plus vitamin C group and 1.84 (0.97) g/dL in the oral iron supplements-only group (between-group difference, 0.16 g/dL; 95% CI, -0.03 to 0.35 g/dL), thus meeting the criteria for equivalence. The mean (SD) change in serum ferritin level from baseline to 8-week follow-up was 35.75 (11.52) ng/mL in the vitamin C plus iron group and 34.48 (9.50) ng/mL in the iron-only group (between-group difference, 1.27 ng/mL; 95% CI, -0.70 to 3.24 ng/mL; P = .21). There were no significant differences between the 2 groups regarding the rates of adverse events (46 [20.9%] vs 45 [20.5%]; difference, 0.4%; 95% CI, -6.7% to 8.5%; P = .82). No patient withdrew because of adverse events. Conclusions and Relevance Among patients with IDA, oral iron supplements alone were equivalent to oral iron supplements plus vitamin C in improving hemoglobin recovery and iron absorption. These findings suggest that on-demand vitamin C supplements are not essential to take along with oral iron supplements for patients with IDA.

啥叫贫血 血常规检查中,红细胞(RBC)减少、血红蛋白(Hb,大家喜欢称为“血色素”)减少或血细胞比容(HCT,就是以前说的“血球压积”)减少,都称为贫血. 正常Hb值在不同性圳、不同年龄、不同海拔高度居住地、不同生理状态的人,会有一些差异.比如婴儿、儿童、妊娠妇女以及血液稀释时,Hb浓度较低,久居高原地区区的居民、因脱水而血液浓缩时,Hb浓度较高. 一股认为,在海平面地区,我国成年男性 Hb低于120g/L,成年女性(非妊娠)Hb低于110g/L,孕妇Hb低于100g/L,即为贫血.国外的标准要高一些.

有时候,医患之间的缘分只有短短的一次门诊,但却带给我长久的温暖.比如那些过了很久还会记得回来告诉我结果的患者,尽管我记不住他们的名字. 戴假发套的姑娘 那位姑娘是因为脱发而到皮肤科就诊的.皮肤科医生发现姑娘贫血,就让姑娘来看血液科门诊,把贫血先治疗一下.

大医院的门诊总是人山人海,是不是就以为医生半天不敢喝水没时间去洗手间,怎一个悲催的"门诊人生"?其实不然,看门诊也是有不少趣事的.像我这种"笑阈"低的人,有时候要使劲憋住笑才行.

患者:“医生,你看,我吃了那么多红枣,这次怎么查出来还是贫血?” 医生:“你贫血,找医生看过吗?” 患者:“没有.” 医生:“为啥不来看啊?” 患者:“大家都说贫血了多吃点红枣就可以了呀.医生,你说我会不会吃到了假红枣啊?” 这样的对话经常在血液科门诊发生.作为血液科医生,实在不能听之任之,大家对贫血是不是有什么误会,认为只要补好了营养就不会有贫血?传说中的吃红枣补血大概指的是红色的枣子应该能补红色的血吧?“吃哈补啥,我妈说的”那还有错? 看来这里的误会有点深,血液科医生觉得应该给大伙儿说说.

〇 仅靠食疗改善贫血,不可能 不少人认为,经常吃红色食物就不会发生贫血,这种说法并不妥当.贫血缺的是红细胞,而红枣、赤豆等红色食物并不是红细胞,所以想单纯靠食疗来预防或治疗贫血并不合适.

他才30多岁,就是一家大型国企的技术骨干,拥有着好几项发明专利;他是家庭的顶梁柱、主心骨,妻子贤惠,小鸟依人,儿子刚上小学;他是一名急性白血病患者——我是他的床位医生. 第一次住院,尽管突如其来的急性白血病让他有些猝不及防,但他还是坚持所有的知情同意书都由他本人来签:做骨穿同意书、做腰穿同意书、化疗同意书、输血同意书……

“医生,我吃了那么多红枣,这次怎么查出来还是贫血?” “大家都说贫血多吃点红枣就可以.医生,我会不会吃到假红枣啊?” 这样的问题经常在血液科门诊出现,作为血液科医生,我实在不能听之任之.大家对贫血是不是有什么误会,认为只要补好营养就不会有贫血?还有传说中的“吃红枣补血”,你真以为红色的枣子能补红色的血?

大部分人认为贫血只是“小事”,并不会致命,只是偶尔头晕,吃点红枣、赤豆补补就好了,何必多花“冤枉钱”到医院治疗;另一些严重贫血的患者,来了门诊也就让医生开补血药.贫血的治疗真那么简单? 贫血不是一种单纯病 事实上,贫血并没有大家想的那么简单.贫血并不是一种疾病,而是一种症状,临床上很多疾病都可以伴有贫血的发生.

王老太太最近脸色不好,没有力气,还时常感觉手麻、脚麻、舌头痛,担心是“小卒中”,去神经内科查过,没发现问题.医生建议她去血液科看看.血液科医生请老人张开嘴,牙齿掉得没剩几颗了.请老人伸出舌头,舌乳头已经萎缩,表面光滑,舌质血红.问老人平时饮食情况,老人抱怨:“牙不好,吃什么也不香,最近又总是舌头痛,就更不想吃东西了.”

目的:报告1例自身免疫性溶血性贫血(autoimmune hemolytic anemia,AIHA)继发纯红细胞再生障碍(pure red cell aplasia,PRCA)危象的病例.方法:对1例AIHA继发PRCA危象患者的临床资料进行回顾性分析,并复习相关文献.结果:患者,女,59岁,因发热伴一过性白细胞、血小板减少,进行性重度贫血8天就诊.辅助检查:重度贫血,肝功能异常,尿胆原(+),血红蛋白尿,乳酸脱氢酶增高,骨穿示红系造血停滞.临床诊断为AIHA继发PRCA危象,病毒感染,肝功能异常.予泼尼松+静脉丙球(IVIG)、输红细胞悬液等治疗.病程3周时脱离输血,肝功能好转.结论:AIHA继发PRCA危象少见且严重.及时去除诱因,予糖皮质激素+IVIG+红细胞悬液输注支持治疗可获痊愈.

血液科门诊,因贫血来就诊的病人很常见.由于贫血是一个被大家“熟知”的疾病,所以很多病人进门就问:医生,我头晕,你看我是不是有贫血?医生,我体检出来有贫血了,开点补血药给我吃吧.医生,我感冒发烧去验血,急诊医生说我有贫血,让我到血液科来开点药吃. 那么,贫血了是不是开点补血药吃就行了呢?答案是否定的.那贫血了应该怎么办?

A multi-center study from the French Myelodysplastic Syndrome (MDS) Group confirmed that iron chelation therapy is an independent prognostic factor that can increase the survival rate of patients who are suffering from transfusion-dependent low-risk MDS. In this study, we aimed to explore this clinical phenomena in vitro, by exploring the synergistic effect of the iron chelator Deferasirox (DFX) and the DNA methyl transferase inhibitor Decitabine (DAC) in the leukemia cell lines SKM-1, THP-1, and K-562. Treatment with both DFX or DAC promoted apoptosis, induced cell cycle arrest, and inhibited proliferation in all three of these cell lines. The combination of DFX and DAC was much greater than the effect of using either drug alone. DFX showed a synergistic effect with DAC on cell apoptosis in all three cell lines and on cell cycle arrest at the G0/G1 phase in K-562 cells. DFX decreased the ROS levels to varying degrees. In contrast, DAC increased ROS levels and an increase in ROS was also noted when the two drugs were used in combination. Treatment of cells with DAC induced re-expression of ABAT, APAF-1, FADD, HJV, and SMPD3, presumably through demethylation. However the combination of DAC and DFX just had strong synergistic effect on the re-expression of HJV.

正常成人体温一般为36～37℃左右,口腔温度(舌下测温)36.3 ～ 37.2℃,直肠温度(肛表测温)一般比口腔高0.3～0.5℃,腋窝温度比口腔温度低0.2 ～ 0.4℃. 发热有时没那么简单 当机体在致热原或各种原因作用下引起体温调节中枢功能障碍时,体温升高超出正常范围,就称为发热.以口腔温度为标准,37.3 ～ 38℃为低热,38.1 ～ 39℃为中等度热,39.1 ～41℃为高热,41℃以上为超高热.

免疫抑制治疗适用于免疫机制介导的血液病,如原发获得性再生障碍性贫血、慢性获得性纯红细胞再生障碍性贫血、自身免疫性溶血性贫血和原发性免疫性血小板减少症等,可选用的免疫抑制剂包括糖皮质激素、抗胸腺细胞球蛋白、抗淋巴细胞球蛋白、环孢素A、静脉注射用丙种球蛋白、硫唑嘌呤、环磷酰胺和利妥昔单抗等.本文介绍免疫抑制剂在上述4种常见血液病治疗中的应用.

当医生，尤其是经常与血液肿瘤打交道的血液科医生，我们总是绕不开死亡这个话题。即使这些年我们治疗白血病、淋巴瘤这些血液肿瘤有了更多的药物和办法，面对死亡束手无策的悲哀涌上心头的时候，我的脑子里总会跳出一本十几年前读过的书--《生命的留言--〈死亡日记〉全选本》。

Objective To explore the demethylation effect of P15INK4 Bgene in myelodysplastic syndrome( MDS)-derived cell line SKM-1 induced by DNA methyltransferase inhibitor Decitabine( DAC). Methods SKM-1 cells in exponential growth phase were set up for 4 groups. 3 DAC groups of SKM-1 cells were treated with 1. 5,3. 0 and 6. 0 mol / L DAC for48 h,untreated SKM-1 cells were the control group. The methylation of P15INK4 Bgene,the expression of P15INK4 Bgene mRNA,the cellular proliferation,the cell cycle and the cellular early apoptosis were detected by methylation specific PCR( MSP),real time fluorescent RT-PCR,CFSE methods,propidium iodide( PI) staining and annexin V-FITC/PI double la-beling. Results( 1) The control group was entirely methylated with P15INK4 Bgene,while 1. 5 mol / L,3. 0 mol / L and 6. 0 mol / L DAC groups underwent partial methylation and showed a unmethylated and darkening strip. The degree of P15INK4 B gene meth-ylation was lower in the groups with higher concentrations of DAC.( 2) The expression of P15INK4 Bgene mRNA in the control group,1. 5 mol / L,3. 0 mol / L and 6. 0 mol / L DAC groups were 1. 00 ± 0. 12,0. 91 ± 0. 13,0. 51 ± 0. 06 and 0. 43 ± 0. 04,respectively. Compared with control group,the expression of P15 I INK4B gene mRNA in DAC groups significantly decreased( P 0. 05). There were no statistical significant differences when compared with DAC groups( P 0. 05).( 3) The MFI of CFSE in the control group,1. 5 mol / L,3. 0 mol / L and 6. 0 mol / L DAC groups were 51. 67 ± 1. 61,55. 33 ± 2. 28,56. 33 ±2. 50 and 55. 71 ± 2. 87,respectively. Compared with control group,the 3. 0 mol / L DAC group significantly decreased( P 0. 05). There were no statistical significances when compared with DAC groups( P 0. 05). 4). The proportion of G1 phase cells in the control group,1. 5 mol / L,3. 0 mol / L and 6. 0 mol / L DAC groups were( 55. 78 ± 3. 61) %,( 48. 12 ±2. 93) %,( 51. 69 ± 1. 60) % and( 46. 71 ± 1. 54) %,respectively. The proportion of S phase cells in the control group,1. 5 mol / L,3. 0 mol / L and 6. 0 mol / L DAC groups were( 44. 22 ± 3. 61) %,( 51. 88 ± 2. 93) %,( 48. 31 ± 1. 60) % and( 53. 29 ± 1. 54) %,respectively. Compared with control group,the proportion of G1 phase cells in 1. 5 mol/L group and6. 0 mol / L DAC group decreased significantly( P 0. 05). With the paired comparison in DAC groups,there was statistical significance between 6. 0 mol / L group and 3. 0 mol / L groups( P 0. 05). 5). The early apoptosis rates in the control group,1. 5 mol / L,3. 0 mol / L and 6. 0 mol / L DAC group were( 2. 91 ± 0. 26) %,( 7. 77 ± 0. 22) %,( 12. 45 ± 0. 28) %and( 13. 86 ± 0. 27) %,respectively. Compared with control group,the early apoptosis rates in DAC groups increased significantly( P 0. 05). There were statistical significance when compared with DAC groups( P 0. 05). Conclusion DAC an induce demethylation of P15INK4 B gene,suppress cellular proliferation,arrest cells in S phase,and promote cellular early apoptosis. The apoptosis rates increases with the increases of DAC concentration in SKM-1 cells. However,P15INK4 Bgene mRNA re-expression with P15INK4 Bgene demethylation did not occur simultaneously.