造血干细胞（骨髓）移植是在治什么？
What does a haematopoietic stem cell (bone marrow) transplant actually treat?
移植的本质是用大剂量化疗或放疗清除患者原有的病态造血与免疫系统，再输入健康的造血干细胞重建骨髓。它用于高危或复发的白血病、淋巴瘤、重型再生障碍性贫血、重型β地中海贫血、镰状细胞病和某些原发性免疫缺陷。异体移植需要HLA相合的供者，主要风险是移植物抗宿主病和长期免疫抑制期间的感染。
The core of a transplant is to wipe out the patient's diseased blood-forming and immune system with high-dose chemotherapy or radiation, then infuse healthy haematopoietic stem cells to rebuild the marrow. It is used for high-risk or relapsed leukaemia and lymphoma, severe aplastic anaemia, severe beta-thalassaemia, sickle cell disease and some primary immunodeficiencies. Allogeneic transplants require an HLA-matched donor, and the main dangers are graft-versus-host disease and infections during prolonged immunosuppression.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 已核验 · Verified 2026-11-03
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葛均波 等主编,《内科学》第9版,人民卫生出版社,2018
Ge Junbo et al. eds., Internal Medicine, 9th ed., PMPH, 2018
独立核验依据 · Independent verification: 核验依据 1 ISBN 9787117265416（豆瓣书目条目: 内科学）
#造血干细胞移植 #HLA配型 #移植物抗宿主病 #再生障碍性贫血
凝血为什么需要维生素K？
Why does blood clotting depend on vitamin K?
凝血因子II、VII、IX、X以及抗凝蛋白C、S在肝脏合成后，必须经过维生素K依赖的γ-羧化修饰，才能结合钙离子并锚定到磷脂膜上发挥活性。维生素K缺乏或使用阻断其循环的华法林时，这些因子活性下降，凝血酶原时间延长，出血风险上升。维生素K来自绿叶蔬菜和肠道细菌合成，因此新生儿和长期使用广谱抗生素者较易缺乏。
Clotting factors II, VII, IX and X, along with the anticoagulant proteins C and S, are made in the liver but must undergo vitamin K-dependent gamma-carboxylation before they can bind calcium and anchor to phospholipid membranes to work. When vitamin K is lacking, or when warfarin blocks its recycling, these factors lose activity, the prothrombin time lengthens and bleeding risk rises. Vitamin K comes from green leafy vegetables and gut bacteria, so newborns and people on long courses of broad-spectrum antibiotics are most at risk of deficiency.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 已核验 · Verified 2026-11-02
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《哈里森内科学》
Harrison's Principles of Internal Medicine
独立核验依据 · Independent verification: 核验依据 1 ISBN 9787518949960（豆瓣书目条目: 哈里森内科学）
#维生素K #凝血因子 #γ-羧化 #华法林
急性早幼粒细胞白血病患者入院时WBC 38×10^9/L、PLT 14×10^9/L,D-二聚体显著升高,纤维蛋白原0.8 g/L。除全反式维甲酸外还应立即采取哪些关键处理?
A patient with acute promyelocytic leukemia is admitted with WBC 38×10^9/L, platelets 14×10^9/L, markedly elevated D-dimer, and fibrinogen 0.8 g/L. Besides all-trans retinoic acid, what key measures must be taken immediately?
该患者实验室检查提示弥散性血管内凝血,应在启动ATRA的同时积极输注血小板维持PLT>30–50×10^9/L,并输注冷沉淀或纤维蛋白原使Fib>1.5 g/L,纠正凝血异常以防致命性出血。同时需监测电解质与肾功能,警惕分化综合征,一旦出现发热伴呼吸窘迫应立即给予地塞米松。早期死亡多因颅内出血,因此支持治疗与诱导治疗同等重要。
This patient shows laboratory DIC: alongside starting ATRA, platelets should be transfused to keep counts above 30–50×10^9/L, and cryoprecipitate or fibrinogen concentrate given to raise fibrinogen above 1.5 g/L to prevent life-threatening hemorrhage. Electrolytes and renal function require monitoring, and differentiation syndrome must be anticipated—fever with respiratory distress calls for immediate dexamethasone. Early death is usually intracranial hemorrhage, so supportive care is as critical as induction therapy.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 来源待核验 · Source pending review
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出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
中国抗癌协会《中国急性早幼粒细胞白血病诊疗指南(2022年版)》 ; 另见: NCCN Clinical Practice Guidelines in Oncology: Acute Myeloid Leukemia, APL section (2024)
NCCN Clinical Practice Guidelines in Oncology: Acute Myeloid Leukemia, APL section (2024) ; see also: 中国抗癌协会《中国急性早幼粒细胞白血病诊疗指南(2022年版)》
#急性早幼粒细胞白血病 #DIC支持治疗与分化综合征
输血为什么一定要先配血型？
Why must blood be typed and cross-matched before transfusion?
红细胞表面带有A、B等抗原，人的血浆中天然存在针对自己所缺抗原的抗体。若输入不相容的血液，抗体会与供者红细胞结合并激活补体，引起急性血管内溶血、休克和肾衰竭，可致命。因此输血前必须做ABO和RhD血型鉴定与交叉配血；紧急情况下常先用O型RhD阴性红细胞作为“万能”过渡。
Red cells carry antigens such as A and B, and plasma naturally contains antibodies against the antigens a person lacks. If incompatible blood is given, those antibodies bind donor red cells and activate complement, causing acute intravascular haemolysis, shock and kidney failure, which can be fatal. That is why ABO and RhD typing plus cross-matching are mandatory, and why group O RhD-negative red cells are used as the emergency stopgap.
难度 进阶 · 适合 大众
CC BY 4.0 · 已核验 · Verified 2026-11-03
来源 · Source
葛均波 等主编,《内科学》第9版,人民卫生出版社,2018
Ge Junbo et al. eds., Internal Medicine, 9th ed., PMPH, 2018
独立核验依据 · Independent verification: 核验依据 1 ISBN 9787117265416（豆瓣书目条目: 内科学）
#输血 #ABO血型 #交叉配血 #溶血反应
血小板在止血中做了什么？
What do platelets do to stop bleeding?
血管破损后，暴露的胶原和血管性血友病因子会让血小板黏附上去并被激活，形状变得不规则、释放颗粒内容物，招募更多血小板通过纤维蛋白原互相连接，先堵成一个“血小板塞”。随后凝血级联生成纤维蛋白网把它加固成稳定血栓。血小板过少会出现皮肤瘀点和牙龈渗血，而阿司匹林正是通过抑制血小板功能来预防血栓。
When a vessel is injured, exposed collagen and von Willebrand factor make platelets stick and become activated: they change shape, release their granule contents and recruit more platelets that link together through fibrinogen, forming an initial platelet plug. The coagulation cascade then weaves a fibrin mesh that reinforces it into a stable clot. Too few platelets leads to pinpoint skin bleeding and oozing gums, and aspirin works precisely by damping platelet function to prevent clots.
难度 进阶 · 适合 小学高段(9-12)
CC BY 4.0 · 已核验 · Verified 2026-10-03 · 3 条独立证据
来源 · Source
Guyton AC,Hall JE. Textbook of Medical Physiology 第14版,Elsevier,2021
Guyton AC, Hall JE. Textbook of Medical Physiology, 14th ed., Elsevier, 2021
独立核验依据 · Independent verification: 核验依据 1 ISBN 978-0-323-59712-8 · 核验依据 2 ISBN 978-1-4557-4377-3 (3rd ed., Elsevier) · 核验依据 3 ISBN 978-1-319-45541-5 (8th ed., Macmillan Learning)
#血小板 #血小板塞 #纤维蛋白 #阿司匹林
白血病到底是什么病？
What exactly is leukaemia?
白血病是造血细胞发生恶性克隆性增殖，异常的白细胞在骨髓里大量堆积，挤占正常造血空间，导致贫血、易感染和出血倾向。按病程分急性与慢性，按细胞来源分淋巴系与髓系，不同类型的治疗和预后差别很大。现代治疗包括化疗、靶向药（如治疗慢性髓性白血病的伊马替尼）、免疫治疗和造血干细胞移植，许多类型的儿童白血病治愈率已相当高。
Leukaemia is a malignant clonal proliferation of blood-forming cells: abnormal white cells pile up in the bone marrow and crowd out normal haematopoiesis, causing anaemia, frequent infections and a tendency to bleed. It is classified as acute or chronic by tempo and as lymphoid or myeloid by cell lineage, and these types differ greatly in treatment and outlook. Modern therapy includes chemotherapy, targeted drugs such as imatinib for chronic myeloid leukaemia, immunotherapy and stem-cell transplantation, and cure rates for several childhood leukaemias are now high.
难度 进阶 · 适合 大众
CC BY 4.0 · 已核验 · Verified 2026-11-03
来源 · Source
葛均波 等主编,《内科学》第9版,人民卫生出版社,2018
Ge Junbo et al. eds., Internal Medicine, 9th ed., PMPH, 2018
独立核验依据 · Independent verification: 核验依据 1 ISBN 9787117265416（豆瓣书目条目: 内科学）
#白血病 #骨髓 #克隆性增殖 #靶向治疗
缺铁性贫血患者口服铁剂治疗两周后,最能提示治疗有效的指标是什么?
In a patient with iron deficiency anemia treated with oral iron, which laboratory finding best indicates a therapeutic response after two weeks of treatment?
网织红细胞计数在服药后5至10天达到高峰,是判断铁剂疗效最敏感的早期指标。血红蛋白通常在治疗两周后才开始上升,约两月后恢复正常。若网织红细胞无相应升高,应考虑依从性差、持续失血或吸收障碍等原因。
Reticulocyte count peaks 5 to 10 days after starting therapy and is the most sensitive early marker of response. Hemoglobin begins to rise only after about two weeks and typically normalizes within two months. A blunted reticulocyte response suggests poor adherence, ongoing blood loss, or malabsorption.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 已核验 · Verified 2026-11-03
来源 · Source
葛均兵 主编,《内科学》第9版,人民卫生出版社,2018（缺铁性贫血章节） ; 另见: Kasper DL, et al. Harrison's Principles of Internal Medicine. 21st ed. McGraw-Hill, 2022 (iron deficiency anemia)
Kasper DL, et al. Harrison's Principles of Internal Medicine. 21st ed. McGraw-Hill, 2022 (iron deficiency anemia) ; see also: 葛均兵 主编,《内科学》第9版,人民卫生出版社,2018（缺铁性贫血章节）
独立核验依据 · Independent verification: 核验依据 1 ISBN 9787117265416（豆瓣书目条目: 内科学）；本条出处含多部著作，此标识只担保上面点名的这部
#血液病学 #缺铁性贫血
评估体内铁储备时,为什么血清铁蛋白比血清铁更可靠?解读铁蛋白结果时要警惕哪些干扰因素?
Why is serum ferritin more reliable than serum iron for assessing body iron stores, and which confounders complicate its interpretation?
血清铁只代表循环中与转铁蛋白结合的铁,昼夜波动明显,并随进食、感染或溶血迅速变化,单次检测意义有限。铁蛋白直接反映网状内皮系统的储存铁,低于30 μg/L 时对缺铁的诊断特异度很高。但铁蛋白同时是急性时相反应物,慢性炎症、肝病和长期饮酒会使其假性升高,此时应联合转铁蛋白饱和度与C反应蛋白综合判断。
Serum iron represents only transferrin-bound circulating iron, varies markedly through the day, and shifts rapidly after meals, infection, or hemolysis, so an isolated value carries little weight. Ferritin mirrors reticuloendothelial storage iron, and levels below 30 μg/L are highly specific for deficiency. Because ferritin is also an acute-phase reactant, chronic inflammation, liver disease, and sustained alcohol intake raise it spuriously, calling for interpretation together with transferrin saturation and CRP.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 已核验 · Verified 2026-11-03
来源 · Source
葛均波 等主编,《内科学》第9版,人民卫生出版社,2018
Ge Junbo et al. eds., Internal Medicine, 9th ed., PMPH, 2018
独立核验依据 · Independent verification: 核验依据 1 ISBN 9787117265416（豆瓣书目条目: 内科学）
#血液病 #缺铁性贫血
O型血曾经是万能供血者?为什么现在医生不再这么说了?
Type O was once called the universal donor — why do doctors avoid saying that now?
ABO系统的逻辑是红细胞上摆什么抗原、血浆里备什么抗体:A型抗B、B型抗A、AB两者皆无、O两者皆有。O型红细胞不带A/B抗原,所以浓缩红细胞可以输给多数人;但O型人的血浆里同时含抗A与抗B抗体,全血输入会攻击受者红细胞。现代输血几乎都用成分血,O型全血并非万能;此外RhD抗原、不规则抗体筛查与交叉配血试验层层把关——所谓万能,只是特定成分在紧急无配型时的权宜说法。
ABO logic: antigens on red cells, antibodies in plasma — group A carries anti-B, B anti-A, AB neither, O both. O red cells lack A/B antigens so packed cells suit most recipients; but O plasma holds anti-A and anti-B antibodies that attack recipient cells in whole blood. Modern transfusion is component-based, so O whole blood is not universal; RhD status, irregular antibody screens and crossmatching add further gates. Universal donor was always shorthand for a specific component under emergency conditions.
难度 入门 · 适合 大众
CC BY 4.0 · 已核验 · Verified 2026-10-04
来源 · Source
Daniels,《Human Blood Groups》第3版,Wiley-Blackwell,2013
G. Daniels, Human Blood Groups, 3rd ed., Wiley-Blackwell, 2013
独立核验依据 · Independent verification: 核验依据 1 ISBN 9780865429147 (2013)
#ABO血型 #交叉配血 #成分输血