CHAPTER 359: 359 THE DISAPPEARING BLOOD PLATELETS

Liu Banxia was currently full of aspirations, as he also needed to strive for his career. This career involved not only solid medical skills but also hospital management abilities and responsibilities.

When it comes to money, I’m nowhere near Qiaoqiao. Only solid medical skills and positions can lift me up a little. It’s indeed a helpless situation, probably one of the ’complications’ of having a rich girlfriend. It’s not like I can completely ignore these things. People might say you can regard money as dirt, but frankly, I hope for a bit more of that ’dirt’ these days.

"President Liu, do you have time now? Could you come over for a consultation?" Zhang Xiao from Neurosurgery called out to him while Liu Banxia was still lost in pleasant thoughts.

"Alright, I’m on my way. What’s the situation?" Liu Banxia hurried over.

He had to be on call for such matters, as he was the chief resident. Moreover, his was a chief resident position with special responsibilities, requiring comprehensive involvement.

"Oh, Boss and Brother Xu are here too? Why didn’t I know about such a severe case?" He was startled to see Shi Lei and Xu Hui there.

"We just came out of surgery. The situation is a bit complicated," Shi Lei said. "The patient, a car accident casualty, was brought in this morning when you weren’t here. He experienced cardiac arrest upon admission. Furthermore, during the physical examination, we found his pupillary response to be poor, so we called Dr. Zhang over, and we performed the surgery together.

"Currently, a splenectomy and external ventricular drainage have been performed to reduce intracranial pressure. The latest CT scan shows no hemorrhage, but there is edema.

"The patient is in our ICU, but his intracranial pressure is slowly increasing. So, we’re currently debating whether to proceed with a decompressive craniectomy or to continue with medical management to control it.

"What’s making our decision difficult is that the patient’s latest blood test results show an extremely low platelet count, which would greatly increase the surgical risk."

Liu Banxia furrowed his brows. This isn’t an easy decision to make.

The primary functions of platelets are hemostasis and coagulation. If the platelet count is critically low, how can surgery be performed? He wouldn’t even meet the criteria for preoperative assessment. Forcing the surgery would likely result in massive hemorrhage for the patient.

However, given the patient’s current condition, if surgery isn’t performed to reduce intracranial pressure, the continually increasing pressure will also be fatal.

"Brother Zhang, how long before the edema could inflict damage to the brain?" Liu Banxia asked.

"We don’t have much time. At most, five to six hours," said Zhang Xiao.

"And ’brain damage’ is just a broad term. Any cerebral edema compressing brain tissue can cause injury."

"This means we don’t have much time. I’m not sure if we should consult the patient’s family and take a gamble. My main concern is that the damage could be irreversible. Otherwise, even if he’s saved, his life would be ruined."

"Yes, that’s the most troubling part. But his platelet count is truly low. I suspect he might become anemic within the next hour or two," Xu Hui added.

"During and after the surgery, we transfused a significant amount of plasma, packed red blood cells, and platelets. Could we induce a medically induced coma to allow his body to recover temporarily? After all, he just came out of surgery and hasn’t recovered from it yet."

"Moreover, this approach might also lower intracranial pressure to some extent, buying us more time, wouldn’t it? At the very least, we might be able to determine the cause of the thrombocytopenia."

Zhang Xiao nodded. "I agree with this, but we would have to set a time limit. We simply cannot afford to wait indefinitely. Any further delay could lead to brain herniation, potentially resulting in a persistent vegetative state or death."

"Boss, what do you think?" Liu Banxia looked at Shi Lei.

Shi Lei shook his head. "This situation is too complicated, and we don’t have much time. Identifying the cause will take time, but the patient’s intracranial pressure won’t afford us that much time."

"How about this: first, we need to thoroughly apprise the patient’s family of the situation and help them understand it fully. The medical advice we can offer is to first induce a therapeutic coma to stabilize the patient’s vital signs," Liu Banxia suggested.

"Simultaneously, we should all carefully consider what’s causing the patient’s thrombocytopenia. Once we determine that, we can decide on a detailed treatment plan."

"Brother Zhang, you’ll have to work hard to continuously monitor this patient’s intracranial pressure. For the timeline, let’s schedule another blood test in an hour and a half. We’ll assess the situation then and discuss further. How does that sound?"

"Although conservative treatment isn’t entirely without risk, it’s at least one of the viable options we can currently consider. If the patient’s platelet count cannot be raised, he truly might not be able to achieve hemostasis during surgery and might not make it off the operating table."

"Alright, don’t worry. I will continuously monitor the patient’s intracranial pressure. This patient is currently one of the most critical cases in the ICU, and they are also giving him close attention," Zhang Xiao replied.

"President Liu, you’ll have to rack your brains. I’ve been thinking for a long time but haven’t figured it out yet," Xu Hui said with a wry smile.

Liu Banxia grinned bitterly. I never expected Xu Hui to pass the buck to me. Is it perhaps because of my impressive performances lately?

"How about this: you’ve all been discussing for a while, and your minds must be cluttered. Let’s each go think about it based on the current diagnostic information. We’ll regroup after the next blood test results come in. Perhaps we’ll have a clearer line of thought by then," Liu Banxia said.

The three of them nodded in agreement. For now, this was the only option.

"Boss, did Xu Hui and Zhang Xiao start to argue just now?" Liu Banxia asked softly after they stepped out.

Shi Lei nodded. "Otherwise, I wouldn’t have suggested Zhang Xiao call you. Right now, only you or the director can mediate. I can’t very well go to the director, can I?"

"Ah... it’s normal to have disagreements. It won’t affect our cooperation in the future, right?" Liu Banxia asked worriedly.

"Don’t worry, they still possess that level of professional ethics. It’s quite normal to have disagreements over diagnostic directions in a case. Haven’t you experienced this before? It’s always about the case, not personal. Everything we do is for the sake of the patient," Shi Lei said.

"But we really do need to address this urgently; otherwise, this patient is truly in grave danger. I’ll go communicate with the family first. After all, I’m relatively neutral, so it wouldn’t be appropriate for either of them to go."

Liu Banxia nodded, feeling a surge of anxiety himself.

They were all experienced physicians. The fact that Zhang Xiao and Xu Hui could have such a dispute demonstrated just how complex and critical the patient’s condition truly was.

One might even say his recent decision was a gamble. Just as Brother Zhang said, the impact of intracranial pressure on the brain can only be roughly predicted.

In principle, it should always be dealt with as quickly as possible.

"President Liu, what’s the matter?" Wang Chao asked curiously.

"I’m mulling over a case. The patient’s platelet count is decreasing, and his intracranial pressure is rising. It’s the car accident patient Shi Lei and the others admitted while I was in Orthopedics," Liu Banxia said.

"If more patients come in, unless it’s extremely urgent or a major accident, don’t call me for now. I need to focus on this patient’s case."

Wang Chao nodded. "No wonder they gathered together after the surgery. I only knew the patient was sent to the ICU; I didn’t expect it to be this severe."

"So, it’s quite a headache. I’m going to take a look now," Liu Banxia said before ducking into his office.

There are so many possible causes for thrombocytopenia. The most common are platelet production disorders, such as aplastic anemia, acute leukemia, or acute radiation sickness. Then there’s increased platelet destruction, from conditions like primary immune thrombocytopenic purpura, hypersplenism, disseminated intravascular coagulation (DIC), or hereditary thrombocytopenia. To pinpoint the cause, I’d have to investigate step by step. But these investigations aren’t straightforward. It’s not like a blood test will make everything crystal clear. More often, blood tests only show the results; then, doctors need to use their knowledge to work backward and find the reason for those results. Considering the known factors, I can rule out a few things. For example, hypersplenism is out since the spleen has been removed. Hereditary thrombocytopenia is also unlikely. But many other possibilities remain. My primary suspicion now is DIC. Major surgery or trauma is one of the underlying conditions that can trigger this complication. It’s highly probable that the car accident and the recent surgery caused DIC in this patient, leading to the low platelet count. However, some aspects don’t quite fit this diagnosis. According to the case notes from the ICU, there’s no visible bleeding from the wounds. Bleeding is a fundamental symptom during the active phase of DIC. The patient’s platelet count, while low, isn’t catastrophically so. And it seems to be decreasing gradually. His current blood tests show normal coagulation function. The crucial issue is time. If we had enough time, we could meticulously rule out causes through various tests. But his intracranial pressure is constantly rising! That will definitely cause brain damage!

After pondering in his office for a while, Liu Banxia slapped his forehead, an idea striking him, and then he rushed out like the wind.

Shi Lei, looking anxious, hurried over. "I was just looking for you! Did the patient’s family agree to an urgent decompressive surgery?"

"Boss, do you think it could be thrombotic thrombocytopenic purpura (TTP)?" Liu Banxia said.

"You mean TTP? Is that possible?" Shi Lei wrinkled his brow and asked in return.

"Possible or not, let’s go straight to the ICU. Get Brother Xu and Zhang Xiao too," Liu Banxia said.

"If that’s truly the case, performing surgery would be a death sentence for the patient. We can’t delay any longer. Let’s go take a look immediately."

Although Shi Lei was still a little unsure, he nodded. After all, for Liu Banxia to suggest it, he must have some basis.