【医学英语】弥散性血管内凝血（病例题）

Question：A 42-year-old African-American man sustains severe injuries in an automobile accident and is admitted to the intensive care unit. Examination of a peripheral blood smear on the 3rd day of admission reveals helmet cells,schistocytes, and decreased platelets. Which of the following is most strongly suggested by these findings?

A. Autoimmune hemolysis

B. Disseminated intravascular coagulation (DIC)

C. Hereditary spherocytosis

D. Megaloblastic anemia

E. Sickle cell anemia

Explanation: The correct answer is B. The findings suggest disseminated intravascular coagulation (DIC), which is a feared complication of many other disorders, such as obstetrical catastrophes, metastatic cancer, massive trauma, and bacterial sepsis. The basic defect in DIC is a coagulopathy characterized by bleeding from mucosal surfaces,thrombocytopenia, prolonged PT and PTT, decreased fibrinogen level, and elevated fibrin split products.Helmet cells and schistocytes (fragmented red blood cells) are seen on peripheral blood smear.Autoimmune hemolysis (choice A) and hereditary spherocytosis (choice C) would be characterized by spherocytes in the peripheral smear.Macro-ovalocytes and hypersegmented neutrophils can be seen in megaloblastic anemia (choice D).Sickle cells are seen in sickle cell anemia (choice E).

词    汇

automobile accident  机动车车祸

intensive care unit  重症监护室

peripheral blood smear  外周血涂片

helmet cell  盔形细胞

schistocyte  裂细胞

autoimmune hemolysis  自身免疫性溶血

spherocytosis  球形红细胞症

megaloblastic anemia  巨幼红细胞性贫血

sickle cell anemia  镰状细胞贫血

解析：正确答案是B。上述表现提示弥散性血管内凝血DIC，DIC是许多疾病的一项可怕的并发症，比如产科重症，转移瘤，巨大创伤，菌血症等。DIC的基本病变是以粘膜表面出血,PT和PTT时间延长,纤维蛋白原水平降低,纤维蛋白裂解产物增高为特征的凝血功能障碍。在外周血涂片可以看到盔形细胞和裂细胞（碎片红细胞）。自身免疫性溶血（A）和遗传性球形红细胞症（C）以外周血中的球形红细胞为特征。巨幼红细胞性贫血以巨卵圆形细胞和多分叶核中性粒细胞为特征（D)。镰状细胞见于镰状细胞贫血(E）。

医学英语栏目：以美国执业医师资格考试（USMLE）为主要推送材料，旨在分享医学词汇及临床病例，提高临床医务工作者的英语学习能力与临床业务水平。

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