The Enhanced Doctor-Chapter 549 Hemophilia?

"Everything else is normal? What about vitamin K? And the DIC test?" Liu Banxia asked after reviewing the test report for a while.

"Everything else is normal, vitamin K levels are normal, and DIC has been ruled out," Xu Yino nodded.

Liu Banxia’s brows furrowed even more tightly. APTT is the activated partial thromboplastin time, Liu Banxia mused. An increase of seven seconds is somewhat awkward. Clinically, it needs to exceed ten seconds to be significant. But considering the patient’s current wound seepage, it’s very likely related to this. An increased APTT is often caused by low levels of factors VIII, IX, or XI. And low levels of these factors often indicate hemophilia, especially since the patient’s vitamin K levels are normal.

Picking up the patient’s file, Liu Banxia reviewed the pre-operative examination results again. Even though he had already looked them over, the results were still normal, all within the acceptable range.

"Dr. Liu, what exactly is going on?" the patient asked.

"Have you typically experienced slow-to-stop bleeding when injured? Or have you had similar symptoms with bleeding gums?" Liu Banxia asked.

The patient shook his head. "No, none of that."

"Do any of your relatives have a history of hemophilia? What about the results of the premarital examination when you got married?" Liu Banxia asked.

"Hemophilia? No one in our family has ever had this disease. Isn’t it hereditary? We never did a premarital check; that was so many years ago. Our child is nine years old now," the patient said.

"Xu Yino, take another blood sample for a hemophilia screening," Liu Banxia instructed.

"Dr. Liu, are you saying I have hemophilia?" the patient asked anxiously.

"Right now, it’s just a hypothesis. We need to do a screening to confirm," Liu Banxia said after a moment’s thought. "Your wound is oozing blood, which I suspect is due to prolonged coagulation time. In many cases, this is caused by a vitamin K deficiency. However, the recent test results showed normal vitamin K levels, so we need to proceed with a hemophilia screening."

"But all your indicators were normal before the operation. If it really is hemophilia, it would most likely be subclinical hemophilia A."

"This type of hemophilia usually doesn’t show symptoms and only manifests to some degree after surgery. Try not to worry yet; this is just my initial assessment."

"Once the test results are out, I’ll need to consult with doctors from our hospital’s hematology department. If it is this kind of disease, a comprehensive treatment plan will be necessary."

"Dr. Liu, does that mean it can be cured?" the patient’s wife asked.

"Let’s wait for the screening results first. It’s genuinely hard to say right now," Liu Banxia replied.

If it’s confirmed, this is a lifelong condition, Liu Banxia thought. They’ll need to be cautious in their daily lives. Still, I shouldn’t burden this couple further without the final test results. Despite this, the couple looked extremely anxious.

"We should do a bedside ultrasound first to see if there is any bleeding inside the abdomen," Liu Banxia suggested.

The patient looked at him and nodded.

Li Hao quickly ran out and brought in the portable ultrasound machine.

After conducting a careful scan, Liu Banxia sighed internally. Even though the test results hadn’t come back, it seemed a diagnosis was close.

"There’s some fluid accumulation in the abdominal cavity. We need to perform a drainage procedure now," Liu Banxia informed him.

"Dr. Liu, just tell me, is it what you suspect? If so, will my son inherit it?" the patient asked.

Liu Banxia shook his head. "A daughter would be a carrier, but your son would be fine. Don’t think too much about it right now. Let me perform the drainage, and then we’ll wait for the results."

Li Hao could perform this procedure. After inserting the tube, some blood did indeed drain out. Although the amount wasn’t large, it was still indicative.

Perhaps Liu Banxia’s assurance that their son wouldn’t inherit the condition brought the couple some comfort, and their mood seemed less downcast.

Liu Banxia didn’t stay in the ward; there was no point in staying. At the moment, it was only a guess, and they still needed to wait for the test results.

After contemplating for a moment, Liu Banxia picked up the phone and called Director Bao Hui of the Hematology Department.

"Hello," Director Bao answered.

"Director Bao, hello. I’m Liu Banxia from the Emergency Center. One of our patients may have hemophilia," Liu Banxia quickly said.

"Did it show up in the pre-surgery blood test?" Director Bao asked.

"Sigh... if only. That might have been simpler," Liu Banxia said, then explained the situation.

"I see. Alright, I’ll come over and take a look," Bao Hui said. "Although the results aren’t out yet, you’ve ruled out DIC and vitamin K deficiency, which is indeed consistent with a subclinical type. Is the bleeding significant?"

"Currently, it doesn’t appear to be excessive," Liu Banxia said.

"Director Bao, in a situation like this, if treatment is given promptly, can the patient recover more quickly? I’ve never encountered such a case and have no experience with it whatsoever."

"That depends on the patient’s specific condition. If it’s confirmed, we’ll also need to assess their sensitivity to treatment. Everyone’s constitution is different, so it’s genuinely hard to say at this point."

"Some of our patients here only have hematomas from bumps and bruises, and it still takes them more than two months to recover. Conditions affecting target joints can be more severe; it’s a very troublesome disease."

"Director Bao, we would appreciate it if you could come over. The patient just had surgery and isn’t stable enough to be moved right now," Liu Banxia said.

"Alright, I’m not busy right now; I’ll head over," Bao Hui responded.

Even though I’ve invited Director Bao for a consultation, I don’t feel entirely at ease, Liu Banxia considered. Bao Hui did say this disease is very troublesome and strongly linked to the patient’s overall physical condition.

After Bao Hui arrived, Liu Banxia handed him the existing test results.

"It’s most likely the case. Let’s wait a bit and see the Factor VIII levels," Bao Hui said after looking through them. "But you guys are lucky. If you had discovered this during the pre-operative examination, how would you have handled it?"

"Er... we probably wouldn’t have paid it much mind," Liu Banxia said with a wry smile. "Thinking about it now, we really dodged a bullet. If the patient decides to make an issue of this, would we also be held responsible?"

Bao Hui nodded. "To some extent, yes. Medical disputes often blur the lines of true right and wrong."

"A deviation of less than ten seconds [increase in APTT] is often considered not clinically significant and is easily overlooked. But in many situations, if there’s external scrutiny or a formal complaint, we often end up bearing 5% to 10% of the responsibility."

"It’s a pre-operative examination, after all. We have an obligation to inform the patient of any abnormal findings. It’s precisely because such findings fall into this gray area—abnormal but not meeting the threshold for strict clinical significance—that they’re easily overlooked. However, the specific nature of hemophilia warrants special consideration."

"Director Bao, what if we encounter similar situations in the future? Do we need to perform hemophilia screenings for everyone?" Liu Banxia asked.

"Seek the patient’s opinion. Subclinical cases like this aren’t very common. It never hurts to be cautious," Bao Hui said with a smile.

"Thank you, Director Bao. I really need to mention this to everyone later," Liu Banxia said sincerely.

"Many hemophilia patients in our country are unaware they have the condition. It’s often only diagnosed after an accident or when it begins to affect some aspect of their physical health," Bao Hui said.

"Its presentation is very subtle and often doesn’t raise immediate concern. Furthermore, some individuals intentionally conceal their condition, failing in their duty to inform their partners, which complicates matters even more."

Liu Banxia nodded. "Perhaps if diseases like AIDS and hemophilia were addressed more stringently by law, there would be fewer such instances of non-disclosure."

"I once treated a patient who had AIDS. He chose to conceal it because he was afraid we would refuse treatment. Thinking back, that was actually quite dangerous for us on the medical team."

"Sometimes, when emergency patients arrive, we can only conduct a verbal inquiry. Some patients arrive without any accompanying family, making even a verbal inquiry challenging before we have to proceed with emergency surgery."

"Things are somewhat better in our country, right? It’s more dangerous abroad. Is Old Zhou in the office?" Bao Hui asked.

"Yes, he is. Director Zhou’s surgery is scheduled for tomorrow," Liu Banxia quickly replied.

"Okay, you carry on. I’ll go chat with Old Zhou for a bit. Let me know when the results are out," Bao Hui nodded.

After Bao Hui left, Liu Banxia rubbed his face. Today was a real stroke of luck, he thought. Otherwise, what Bao Hui described could easily have happened.

"Sorry about that, I almost got you into trouble," Shi Lei said as he came over.

"Hey, don’t say that. Who could have anticipated this?" Liu Banxia shook his head. "We asked the patient about these things, and he didn’t intentionally conceal anything. The pre-operative examination results were all within normal limits. This is just an unforeseen event."

"As doctors, don’t we face plenty of unexpected situations? It’s just part of the job, I suppose. But we really do need to be more vigilant in the future."

"But we can’t just bring this up with a patient every time the APTT slightly exceeds the standard value, can we? After all, many factors can prolong APTT. What would be an appropriate threshold?"

"Don’t ask me about that; you should discuss it with the director," Shi Lei shook his head. "I don’t think any specific number would be easy to set. Take today’s patient, for example—his pre-operative tests were normal. So, what would be an appropriate cutoff?"

Liu Banxia was at a loss for words. No value seems right, he thought.

I really was lucky today, Liu Banxia reflected. We encountered reasonable patients and their family. If we’d dealt with the type who love to make a fuss, this could have escalated into a major problem.