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- 摘要：A 51-year-old male patient was admitted in March 2025 due to fever without obvious inducement, accompanied by sore throat, cough and yellow sputum. He had a history of chronic lymphocytic leukemia(CLL) for more than one year. C-reactive protein (CRP) >200 mg/L was detected in an outside hospital, and anti-infective treatment with ceftriaxone failed to improve his symptoms. After admission, relevant examinations showed elevated hypersensitive C-reactive protein(hs-CRP) and procalcitonin(PCT), abnormally increased liver enzymes and creatine kinase (CK), as well as multi-system injuries such as hyponatremia-hypochloremia and hypoalbuminemia. The results of routine etiological screening and blood culture were negative. Bone-marrow aspiration and imaging examinations indicated stable bone-marrow manifestations of CLL, with only pulmonary infectious lesions and mildly enlarged lymph nodes, and no typical B-symptoms or extranodal invasion, so the progression of CLL was excluded. Bronchoalveolar lavage fluid was collected for targeted next-generation sequencing(tNGS), and Chlamydia psittaci(Cps) was detected with a high sequence number. After supplementary epidemiological history-taking, pigeon-exposure before disease onset was confirmed, and Cps infection was diagnosed. Cephalosporin antibiotics to which the pathogen was resistant were discontinued during treatment. Enhanced anti-infective therapy with doxycycline combined with moxifloxacin was administered, and the patient’s condition and laboratory indicators were dynamically monitored. After treatment, the patient’s body temperature returned to normal, all inflammatory markers decreased significantly, and pulmonary infectious lesions were absorbed. This case highlights the diagnostic value of tNGS for difficult-to-diagnose atypical-pathogen infections in immunocompromised hosts and verifies the importance of detailed epidemiological history collection, which can provide a reference for the diagnosis and treatment of similar clinical cases.关键词：Targeted next-generation sequencing;Chlamydia psittaci;Opportunistic infection;Chronic lymphocytic leukemia13|1|0更新时间：2026-08-25
- 摘要：A 58‑year‑old male patient presented with recurrent high fever, sore throat, arthralgia and calf eschar as the initial manifestations. He was tentatively diagnosed with infection and Adult‑Onset Still’s Disease during multiple early hospital visits. After comprehensive detection of autoantibodies, he was finally confirmed to have melanoma‑differentiation‑associated gene 5 antibody‑positive dermatomyositis (MDA5+DM) complicated with rapidly‑progressive interstitial lung disease (RP‑ILD). This case reviews the whole clinical course from misdiagnosis as suspected infection, recognition of clinical clues, autoantibody screening to definitive diagnosis, and analyzes the difficulties in early identification of MDA5+DM. It suggests that combined detection of disease‑specific autoantibodies should be performed as early as possible for patients with non‑specific systemic symptoms accompanied by pulmonary lesions, so as to reduce missed diagnosis and misdiagnosis, and provide reference for clinical diagnosis and treatment of such diseases.关键词：melanoma-differentiation-associated gene 5 antibody-positive dermatomyositis;rapidly-progressive interstitial lung disease;autoantibodies13|0|0更新时间：2026-08-21
- 摘要：The infant was a very low birth weight premature infant delivered by cesarean section at 31+4 weeks of gestation. The mother was an elderly pregnant woman with syphilis, and she had completed the standard full-course anti-syphilis treatment during pregnancy. After birth due to premature birth and severe asphyxia, the infant was transferred to the pediatric department for symptomatic treatment after resuscitation. From birth to three months of age, the serum syphilis treponemal antibody (Syphilis TP) and toluidine red unheated serum test (TRUST) were dynamically followed up. After multi-dimensional investigation to exclude detection errors, the results showed that: Syphilis TP was positive, and TRUST and all titers were negative on the first day after birth; Syphilis TP was weakly positive at 2 months of age, and TRUST was still negative; Syphilis TP turned negative at 3 months of age. It was considered to be maternal passive transfer of syphilis antibodies. Anti-syphilis treatment was not given, and only symptomatic treatment was provided. After the treatment course, the condition was stable and the infant was discharged from the hospital. Follow-up indicated that the antibodies gradually turned negative, and there was no adverse prognosis.关键词：Syphilis in pregnancy;Neonatal congenital syphilis;Pregnancy outcome31|0|0更新时间：2026-08-20
- 摘要：A 42-year-old male patient was admitted to the Fifth People’s Hospital of Yibin on April 16, 2025, presenting with fever (predominantly nocturnal high fever), chills, cough, expectoration, accompanied by palpitation, fatigue, abdominal distension and anorexia. On admission, his body temperature was 39 ℃; multiple erythematous macules were observed all over the skin, with abnormal auscultation findings and impaired verbal communication. Laboratory examinations revealed markedly elevated inflammatory markers including white blood cell count, neutrophil count, C-reactive protein and procalcitonin. Chest CT showed multiple infectious lesions in the right lung. HIV antibody test was positive, and the baseline CD4⁺T lymphocyte count was only 7 cells/μL. Extended bilateral blood culture yielded Talaromyces marneffei. Nucleic acid testing for six respiratory pathogens confirmed human rhinovirus (HRV) positivity. Based on medical history, clinical manifestations, physical signs and auxiliary examinations, the patient was definitively diagnosed with acquired immunodeficiency syndrome (AIDS) complicated by Talaromyces marneffei sepsis and human rhinovirus infection. Antiretroviral therapy consisting of tenofovir disoproxil fumarate combined with lamivudine and efavirenz was initiated. Meanwhile, voriconazole was administered for antifungal treatment and Yanhuning for antiviral symptomatic management. After systematic treatment, the patient’s clinical symptoms improved significantly with negative follow-up blood culture results. Repeated chest CT demonstrated absorption and reduction of pulmonary infectious lesions. HRV nucleic acid turned negative at the 2-week follow-up after discharge, indicating favorable recovery.关键词：AIDS;Human rhinovirus;Talaromyces marneffei;Co-infection22|0|0更新时间：2026-08-18
- 摘要：A 23-year-old female patient with a 1-year history of untreated hyperthyroidism presented with rapid deterioration triggered by mild upper respiratory tract infection, and progressed to thyroid storm (TS) within 48 hours. Physical examination upon admission revealed that her BMI was merely 15.8 kg/m². During hospitalization, she developed typical manifestations of multisystem involvement including sinus tachycardia, myocardial injury, liver dysfunction and hypokalemia successively. Rapid clinical diagnosis and urgent systematic comprehensive treatment were implemented, resulting in prompt and effective control of her condition. This case suggests that patients with long-term uncontrolled hyperthyroidism have reduced bodily tolerance, and mild respiratory tract infection may trigger TS. Extremely low BMI can serve as an important risk marker for the occurrence of such crisis. This report provides critical insights for early clinical identification and management of this emergency, and facilitates the optimization of management strategies to improve patient prognosis.关键词：upper respiratory tract infection;thyroid storm;BMI;risk factors34|1|0更新时间：2026-08-07
- 摘要：A 64-year-old male patient was admitted to hospital with recurrent fever for more than two months. Preoperative laboratory tests revealed perioperative coagulation disorders, manifested as severe hypofibrinogenemia and thrombocytopenia, and serial dynamic monitoring of coagulation parameters was carried out throughout hospitalization. Physical examination showed no precordial bulge, normal cardiac dullness border, regular heart rate of 78 beats per minute. A diastolic murmur was heard over the aortic valve auscultation area, without extra heart sounds or gallop rhythm, and peripheral vascular signs were negative. Combined with clinical manifestations and transthoracic echocardiography findings, the patient was diagnosed with infective endocarditis, congenital bicuspid aortic valve, severe aortic regurgitation complicated with mild-to-moderate aortic stenosis. During treatment, subcutaneous injection of recombinant human thrombopoietin (TPO) was administered to elevate platelet count, combined with transfusion of platelet and other blood components, as well as intravenous infusion of human fibrinogen to correct coagulation defects. After thorough preoperative evaluation, the patient underwent Bentall procedure consisting of aortic valve replacement, ascending aorta replacement and coronary artery reimplantation. The patient maintained stable vital signs postoperatively, with clean and dry dressing on thoracic surgical incision and no signs of active bleeding. He was discharged after clinical stabilization, with instructions to take oral warfarin for lifelong standardized anticoagulation and receive regular follow-up with coagulation function monitoring.关键词：coagulation function indicators;cardiac surgery;perioperative period29|0|0更新时间：2026-08-05
- 摘要：A 45-year-old female patient was found to have abnormally elevated carbohydrate antigen 72-4(CA72-4) during a routine physical examination in August 2024 and was hospitalized for etiological screening. She had no gastrointestinal discomforts including nausea and abdominal pain, no weight loss or fatigue, with good overall physical condition and no family history of tumors. The initial serum CA72-4 level was higher than 300.00 U/mL(reference range: 0~6.9 U/mL). Repeated testing yielded identical results. The internal quality control was acceptable on the testing day, and no hemolysis, lipemia or other abnormalities were detected in the submitted specimens. Alpha-fetoprotein(AFP), carcinoembryonic antigen(CEA), carbohydrate antigen 199(CA199) and other tumor markers, together with liver function parameters, were all within normal limits. Endoscopic examination revealed no space-occupying lesions, which basically ruled out malignant tumors and associated benign disorders. Detailed medication history inquiry showed that the patient had persistently taken Ganoderma lucidum spore powder recently. She was instructed to stop this nutritional tonic immediately, and no anti-tumor pharmacological intervention was administered temporarily. After discontinuation, her CA72-4 level gradually returned to the normal reference range. This case suggests that Ganoderma lucidum spore powder can induce false-positive elevation of serum CA72-4. When interpreting abnormal tumor marker results, clinicians and laboratory physicians should comprehensively evaluate patients’ medication history and nutritional tonic intake history, distinguish the validity of test results based on full clinical data, so as to prevent misdiagnosis and overtreatment.关键词：carbohydrate antigen 72-4;Ganoderma lucidum spore powder;tumor marker;false positive25|1|0更新时间：2026-08-03
- 摘要：A 33-year-old female with a history of sickle cell trait (sickle cell trait, SCT) presented anemia on routine blood test during follow-up at the Department of Cardiology, Shanghai Jiahui International Hospital in August 2022. She had no signs of mucocutaneous hemorrhage, hematemesis, melena or other gastrointestinal bleeding, and was subsequently referred to the Department of Hematology for further evaluation. The patient complained of recurrent right lower extremity muscle pain accompanied by dizziness and general fatigue. Family history: a maternal family history of anemia, while her siblings had no history of anemia. Laboratory examinations revealed microcytic hypochromic anemia with a reticulocyte (Ret) count of 1.21%. Peripheral blood smear showed anisocytosis, with sickled red blood cells accounting for 4.00% and target cells accounting for 12.5%. Iron metabolism tests: serum ferritin (Fer) 10 μg/L, serum iron (Fe) 7.83 μmol/L. Hemoglobin zone electrophoresis demonstrated hemoglobin S (HbS) 27.00%, hemoglobin A₂ (HbA₂) 3.80%, hemoglobin A (HbA) 69.20%, and hemoglobin F (HbF) 0.00%. Genomic testing for hereditary hematological diseases identified a heterozygous HBB gene CD6 (GAG>GTG) mutation combined with homozygous -α³·⁷ deletion. Based on the patient’s medical history, family history and laboratory findings, the final diagnosis was sickle cell trait complicated with homozygous α-thalassemia and iron deficiency anemia. The patient received standardized intravenous iron supplementation with iron sucrose injection. Complete blood count and serum ferritin were monitored regularly to prevent iron overload. The patient was advised to avoid strenuous exercise and overexertion and keep warm in daily life. During follow-up, iron deficiency anemia was effectively corrected, and hemoglobin returned to the normal reference range. The proportion of sickled red blood cells in peripheral blood smears decreased, whereas the proportion of target cells remained stable. No serious adverse events including iron overload, hemolytic crisis or vaso-occlusive complications were observed, and the patient’s condition remained stable overall.关键词：Sickle Cell Trait;α-thalassemia;Iron Deficiency Anemia48|0|0更新时间：2026-08-03
- 摘要：A 54-year-old female patient had been diagnosed with anemia for 1 year and was treated with Yiqi Weixue Capsules without effect. Three days ago, she developed fever (maximum 39 ℃), nausea and vomiting with blood streaks, and upper abdominal pain without obvious inducement, accompanied by palpitation, chest tightness, frequent urination and dysuria, and was admitted to our hospital. Routine blood test showed severe microcytic hypochromic anemia, abnormal ratio of red blood cell count to hemoglobin, and tailing of platelet histogram. Biochemical examination showed normal serum iron and elevated ferritin, excluding iron deficiency anemia. Target cells and teardrop cells were found by peripheral blood smear microscopy. Combined with the patient's Guangxi origin and family history of anemia, RBC×100/MCV and Mentzer index were calculated to screen for thalassemia. Finally, she was diagnosed with α combined β thalassemia by thalassemia gene detection, and her daughter was also detected with α thalassemia gene mutation. At present, the patient has been transferred to the specialist department for targeted treatment.关键词：Thalassemia;Routine Blood Test;Blood Smear;Gene Detection;Microcytic Hypochromic Anemia69|4|0更新时间：2026-07-14
- 摘要：A 54-year-old female patient was admitted to the hospital for dysphagia lasting 10 days and retrosternal pain for 10 hours. She had a past medical history of cerebral infarction and myocardial ischemia, and had been taking atorvastatin and other medications on a long-term basis. No significant positive signs were found on physical examination at admission. Routine biochemical tests detected a creatine kinase (CK) activity of 646 U/L and a CK-MB activity of 1 241 U/L, showing an abnormal pattern where CK-MB activity was markedly higher than total CK activity. Through stepwise diagnostic workup including sample dilution test, CK-MB mass assay, cranial magnetic resonance imaging (MRI) and polyethylene glycol (PEG) precipitation test, the abnormality was finally attributed to macro creatine kinase (macro CK) interference. Proactive identification of abnormal results by the clinical laboratory, followed by verification with methods such as dilution test, CK-MB mass assay and PEG precipitation, is critical to avoiding misdiagnosis and mistreatment.关键词：macro creatine kinase;creatine kinase;creatine kinase isoenzyme;interference46|1|0更新时间：2026-07-10
- 摘要：The patient presented with a six-month history of exertional dyspnea and chest tightness, which had exacerbated over the past two weeks, accompanied by an anemic appearance. Based on the clinical history, electrocardiogram, gynecological ultrasound, and laboratory findings (including complete blood count and iron studies), the patient was diagnosed with iron-deficiency anemia, sinus tachycardia, grade 2 hypertension (very high risk), hyperlipidemia, and uterine fibroids. During the blood grouping process, the patient’s red blood cells exhibited weakened reactivity with anti-B antibodies. Given the absence of prior blood transfusions, transplants, hematologic malignancies (such as leukemia), or specific medication history, an ABO subgroup was suspected and subsequently confirmed as an AB subgroup through further identification. Considering that allogeneic transfusion should be approached with extreme caution in patients with ABO subgroups and that the anemia was primarily iron-deficient in nature, iron supplementation was administered. The patient remained clinically stable with no significant adverse symptoms following treatment.关键词：ABO blood type;blood subtypes;rare blood types;blood transfusion;weak agglutination29|4|0更新时间：2026-07-10
- 摘要：A 35-year-old female patient presented with scleral icterus for more than 12 years and intermittent pruritus, and was finally diagnosed with primary biliary cholangitis (PBC). During diagnosis and treatment, the patient showed significantly elevated and fluctuating levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), accompanied by markedly increased liver function indexes such as bilirubin and transaminase. The laboratory department verified the instrument operation status, internal quality control, reagent validity period, and repeated detection with alternative equipment, and no abnormalities were found in the detection system. Literature analysis confirmed that lipoprotein X (LpX), an abnormal lipoprotein specifically present in the plasma of patients with cholestasis, could seriously interfere with the routine blood lipid detection system and cause pseudo-elevation of LDL-C and TC results, thereby misleading clinicians in the evaluation of cardiovascular risk and formulation of diagnosis and treatment plans. After clarifying the etiology, the patient was prioritized for primary disease treatment of PBC without blind lipid-lowering intervention. Finally, the patient's condition improved, blood lipid indexes returned to normal, and the clinical outcome was favorable. This case suggests that when reviewing abnormal blood lipid test results, laboratory staff should fully combine the patient's underlying medical history, avoid methodological interference, actively identify pseudo-abnormal results and communicate with clinicians in a timely manner, so as to give full play to the auxiliary diagnostic value of laboratory clinical thinking.关键词：Primary biliary cholangitis;Lipoprotein X;Low-density lipoprotein cholesterol;Detection interference76|5|0更新时间：2026-07-10
- 摘要：A 44-year-old male patient was admitted with dizziness and diarrhea, presenting with a 10-year history of hypertension. Routine fecal examination indicated a negative occult blood test and 0-1 red blood cells per high-power field (RBCs/HP). Based on the medical history and morphological re-examination, the clinical diagnoses were cerebral infarction and Blastocystis hominisinfection. The patient received oral metronidazole (400 mg three times daily) combined with probiotics to modulate the intestinal flora. After 7 days of treatment, diarrhea symptoms alleviated, and follow-up fecal routine examination revealed no parasites. Blastocystis hominisis a common intestinal protozoan characterized by pleomorphic morphology, frequently causing diagnostic confusion with RBCs, fat droplets, and Giardia lamblia. This case report summarizes the microscopic features of vacuolar-form Blastocystis hoministo enhance the identification capability of laboratory personnel, thereby reducing misdiagnosis and providing reliable evidence for clinical diagnosis and treatment.关键词：Blastocystis hominisinfection;Intestinal protozoal infection;Laboratory diagnosis;Stool examination;Giardia lamblia23|1|0更新时间：2026-07-10
- 摘要：A 10-year-old male patient was admitted due to intermittent chest pain for 2 months. The chest pain was stabbing in nature, alternating between left and right sides, each episode lasting 1 to 3 seconds, without sweating, palpitations, or fever. He had occasional nasal discharge in the past 3 to 5 days. An outside hospital reported myocardial enzyme panel showing creatine kinase (CK) at 1 168.4 U/L and creatine kinase isoenzyme-MB (CK-MB) at 2 108 U/L, presenting a paradoxical phenomenon of CK-MB>CK, while cardiac troponin Ⅰ(cTnⅠ) within normal limits. Upon admission, repeat myocardial enzyme testing still showed CK-MB>CK, but cardiac troponin and cardiac magnetic resonance imaging were both normal, indicating a discrepancy between laboratory findings and clinical presentation. The laboratory department conducted serial dilution assays to exclude heterophilic antibody interference, followed by polyethylene glycol (PEG) precipitation, which revealed a CK recovery rate of only 24.5%, strongly suggesting the presence of macro-CK. Final confirmation was obtained through CK-MB mass concentration assay showing normal CK-MB levels, leading to the diagnosis of benign macro-CKemia. Benign macro-CKemia can cause falsely elevated CK-MB activity by the immunoinhibition assay, leading to the paradoxical phenomenon of CK-MB > CK, which is not indicative of cardiac injury. It is essential for the laboratory to proactively identify abnormal results and adopt a stepwise verification strategy including dilution test, PEG precipitation, and CK-MB mass assay to avoid misdiagnosis. The patient received no specific treatment and was discharged uneventfully after symptomatic management.关键词：Macro-CKemia;Creatine kinase isoenzyme-MB;Immunoinhibition method60|1|0更新时间：2026-07-02
- 摘要：The patient was a 57-year-old male with repeated fatigue and jaundice for more than 50 years, accompanied by tea-colored urine. He had a history of anemia for over 10 years. In February 2025, he presented with pancytopenia and massive splenomegaly, and underwent laparoscopic total splenectomy at an outside hospital. Only the platelet count returned to normal postoperatively. Routine blood tests on admission showed decreased white blood cell count and hemoglobin level, and an elevated reticulocyte percentage. Peripheral blood smear revealed approximately 10% spherocytes, nucleated red blood cells, and Pappenheimer bodies. Whole-exome sequencing identified a pathogenic mutation in the SPTB gene (encoding β-spectrin) and a myeloid neoplasm-associated mutation in DNMT3A. A diagnosis of hereditary spherocytosis (HS) complicated by clonal cytopenia of undetermined significance (CCUS) was made. During follow-up, the patient had chronic severe anemia requiring blood transfusion support. No other treatments or interventions were administered locally, and long-term monitoring of clonal mutation burden was not performed; thus the risk of disease progression could not be assessed at present. The coexistence of HS and CCUS is clinically rare and prone to misdiagnosis or missed diagnosis. Integrating clinical, morphological and genomic evidence is essential for accurate diagnosis and personalized management.关键词：Hereditary spherocytosis;Clonal cytopenia of undetermined significance;Anemia;β-spectrin49|3|0更新时间：2026-07-02
- 摘要：A 59-year-old male was diagnosed with mild macrocytic anemia during a health examination, without any specific complaints. Complete blood count revealed macrocytic anisocytosis, and microscopic examination showed red blood cell size variation and neutrophilic hypersegmentation. Follow-up complete blood count and blood smear microscopy, combined with complete biochemical panel (elevated bilirubin, lactate dehydrogenase, and homocysteine) and anemia panel (decreased vitamin B12, normal folate and ferritin), confirmed the diagnosis of vitamin B12 deficiency megaloblastic anemia based on the diagnostic criteria for megaloblastic anemia. Targeted vitamin B12 supplementation was administered to correct hematopoietic substrate deficiency and correct cellular DNA synthesis disorders. After standardized treatment, the patient's hematopoietic function gradually recovered, with complete blood count, biochemical, and anemia panel indicators all returning to normal. No anemia-related neurological or digestive symptoms were observed, and the clinical outcome was favorable.关键词：Peripheral blood smear;Megaloblastic anemia;Vitamin B1241|0|0更新时间：2026-07-02
- 摘要：Blood routine tests are the most fundamental and widely applied screening procedures in clinical diagnostics, capable of rapidly reflecting hematopoietic function and overall health status, providing crucial clues for early disease identification. This article reports a case of an elderly patient presenting primarily with fatigue and pathological fractures. The blood routine test revealed a characteristic "hanging top phenomenon" in the lymphocyte scatter zone, which, combined with instrument alerts and peripheral blood smear microscopy, provided significant evidence for early disease identification. Subsequent biochemical tests, immunofixation electrophoresis, and bone marrow examination confirmed the diagnosis of immunoglobulin G-κ type multiple myeloma. After establishing the diagnosis, the patient was treated with a bortezomib-based combination chemotherapy regimen. Post-treatment, the patient's anemia and fatigue symptoms improved, and the condition stabilized. This case highlights that attention to abnormal blood routine scatter plots and detailed analysis by laboratory personnel can significantly enhance the early diagnosis rate of multiple myeloma, offering strong support for timely clinical intervention and improved patient prognosis.关键词：Blood routine tests;Multiple myeloma;Plasma cell24|1|0更新时间：2026-07-02
- 摘要：Platelet count is a key indicator in routine clinical blood tests and is prone to spurious abnormalities affected by multiple factors. Among them, spurious normality of platelets is easily overlooked as the value falls within the reference range, which carries potential risks in diagnosis and treatment. This paper reports a laboratory case of spurious normality of platelet count in a healthy individual undergoing physical examination. The examinee had no underlying medical history or clinical symptoms. Initial screening of platelets by the impedance method in routine blood analysis yielded a result of 159×109/L, which was within the normal range. However, the instrument flagged an abnormal platelet histogram, accompanied by abnormal indicators such as microcytic hypochromic anemia and anisocytosis. Based on morphological features of the histogram, laboratory personnel promptly performed a recheck using the highly specific low platelet count optical channel, supplemented by blood smear microscopy for verification. Finally, the initial platelet result was confirmed to be spuriously normal, with the true count being 62×109/L. The core of this case lies in the precise identification of interference during the diagnostic process, enabling clinicians to administer targeted treatment accordingly. Through analysis of this case, it is emphasized that laboratory staff should attach importance to instrument alarm information and histogram interpretation, be familiar with testing principles, standardize review procedures, and rationally apply optical channels and microscopic review. These measures can effectively prevent the reporting of spurious platelet results, improve laboratory accuracy, and ensure the safety of clinical diagnosis and treatment.关键词：Platelets;Platelet Histogram;Blood Smear120|10|0更新时间：2026-05-21
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