临床带教 | 特发性血小板减少性紫癜

小白老师说：你懈怠没人替你努力，你脆弱没人替你坚强，你消沉没人替你积极，你纠结没人替你淡定，你放弃没人替你坚持。有些事要独自做，有些路要独自走。嗯，先干了这碗鸡汤，然后一起来听今天的医学英语对话。

PS，小白老师今天的音频录得很有趣，这位实习生听起来垂头丧气爱答不理的，真要在医院里该会被主任骂死吧哈哈！ 大家一听便知。

Idiopathic Thrombocytopenic Purpura （ITP）

特发性血小板减少性紫癜

Attending: Anything interesting to talk about today?

主治：今天有什么感兴趣的问题要谈吗？

Intern: A case of ITP came in last night.

实习生：昨天夜间住进了一名特发性血小板减少性紫癜患者。

Attending: Why do you say it’s ITP?

主治：你根据什么说那是特发性血小板减少性紫癜？

Intern: Well, both the history and the physical seem substantiate this feeling.

实习生：嗯，不论是病史还是体检都支持这一印象。

Attending: What did you find?

主治：你都发现了什么？

Intern: This is a fifteen-year-old boy who was apparently in good health until about four days prior to admission. At that time he began to find some petechiae on the surfaces of his neck and epistaxis happened. On physical examination the vital signs were within normal limits, some petechiae and ecchymoses were found on the surfaces of the legs, arms and chest. The lab examination showed that his HB and WBC were normal. But the platelet count was very low, only 20×109/L.

实习生：患者是一名 15 岁的男孩。以往身体健康，入院前 4 天在颈部皮表发现一些淤点，并有鼻衄。体检时生命体征均正常，在其大腿、手臂及胸部表皮可见及瘀斑。实验室检查血红蛋白及白细胞均正常。但血小板计数很低，仅 20×109/L。

Attending: Has his bone marrow been examined?

主治：做骨髓象检查了吗？

Intern: No.

实习生：没有。

Attending: What could you find in the bone marrow if this case was suffered from ITP?

主治：如患者确为 ITP，其骨髓象会有什么改变？

Intern: The erythropoiesis and myelopoiesis should be normal and megakaryocyte number should be very high.

实习生：红系和粒系造血正常，巨核细胞数目增高。

Attending: OK. Let’s go in and see him.

主治：很好！让我们一起去看看病人吧。