女性，12岁，反复巩膜黄染6年。体检：巩膜轻度黄染，肝肋下1cm，脾肋下3cm。检验：血红蛋白90g／L，白细胞及血小板正常，网织红细胞11.2％；总胆红素34μmol／L，间接胆红素28μmol／L，HBsAg（+）；Coombs试验（-），红细胞渗透脆性增加。最可能的诊断是（）
A.先天性非溶血性黄疸
B.遗传性球形红细胞增多症
C.自身免疫性溶血性贫血
D.珠蛋白生成障碍性贫血
E.慢性肝病性贫血
参考答案：B
解析：贫血、黄疸和脾肿大，是HS最常见的临床表现。HS网织红细胞增加（0.05～0.20），红细胞渗透脆性增加。
A saint (圣人) found a group of family members shouting angrily at each other on a river bank. He asked his disciples(信徒), “ 1 do people shout when they are angry with each other?” The disciples 2 for a while and one of them said, “Because they lose their calm.” “But why should they shout when the other persons are just 3 them? They can tell them what they have to say in a 4 manner.” Asked the saint. The disciples gave some other answers but 5 made the saint pleased. Finally the saint 6 , “When two people are angry with each other, their hearts distance a lot. To cover that distance they must shout in order to 7 each other. The angrier they are, the 8 they will have to shout to cover that great distance. What happens when two people fall in love? They don’t shout at each other but talk softly, because their hearts are very close. The distance 9 them is very small or doesn’t exist(存在).” The saint looked at his disciples and continued, “So when you argue with other people, do not say words that distance each other, or else there will come a day when the distance is so great that you will not find the 10 to return.
|