Patient: Wandering pain in bones all over the body, especially pronounced sternal and axillary pressure pain. Chronic low fever, around 37°, not exceeding 37.3°, nasal congestion, cold symptoms. Large purple tongue, thick white tongue coating, many bleeding and bruising spots on top of the tongue. Mucus, unformed stools, abdominal rumbling, and many farts. Weakness, severe spontaneous sweating and night sweating. After the injection, cyanosis and bruises easily appeared on the arms, and there were bleeding spots on the body and arms, not many, which disappeared automatically after two or three days. The symptoms appeared until now about 55 days! After the symptoms appeared, I visited the internal medicine department of the local tertiary hospital. The doctor said that the blood routine was normal, bone aspiration was normal, colonoscopy was normal, and whole abdominal ultrasound was normal except for 0.4 and 0.7 stones in both kidneys. Urine routine red blood cells 29 (high), occult blood a “+”. The coagulation tetralogy: PT, 10.4 s, ratio/PTR 0.86, INR 0.82, APPTT 24.8 s, TT 11.0 s, FBG 13.5 s, concentration 359.4 mg/dl. The biochemical and immunological tests were normal except for high transaminases, and the rheumatoid factor test was normal. Internal medicine doctor diagnosed rheumatoid arthritis and enteritis, and discharged after 7 days of symptomatic treatment without improvement, and now the symptoms persist. I suspect that it is a hematological disease. I would like to ask Dr. Liu to analyze the symptoms, blood count and bone penetration report to see if it is true erythropoietic hyperplasia. Thank you! Liu Jiajun, Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University: Hello! From the various indicators examined, the bone marrow is basically normal and the peripheral blood eosinophils are slightly high (increased eosinophils are commonly seen in allergic diseases). There is no evidence of true erythrocytosis, so there is no need to worry. Thanks for the consultation and good luck! Patient: Sorry to bother you again, Dr. Liu! Thank you very sincerely for your reply to me. I have 3 more questions: 1. In your reply, you said that the bone marrow is basically normal, does it mean that there are still abnormalities and what are they? I would like to ask you to clarify this for me. 2.The local hematologist said that he could rule out blood-related diseases, and I am now taking Chinese medicine to regulate my condition. 3. 10 days after the last examination, I went to the hospital for a routine blood test, and my white blood cell count was 5.20 (0.71 lower than last time), eosinophil count was 3.1% (2.5% lower than last time), red blood cell count was 5.15 (0.11 higher than last time), HGB hemoglobin was 168 (8 higher than last time), HCT red blood cell pressure was 0.48 (0.03 higher than last time), MCV mean red blood cell volume 92.6 (0.5 higher than last time), MCH mean hemoglobin volume 32.5 (0.8 higher than last time), MCHC mean red blood cell hemoglobin concentration 351 (6 higher than last time), R-SD red blood cell distribution width (SD) 42.9 (0.1 higher than last time), R-CV red blood cell distribution, width (CV) 13.0 (unchanged), PLT platelets 183 (17 lower than last time), and all other normal. From the report, it seems that all indicators of the red system are more or less slightly increased, is this normal? Is it necessary for me to go to a provincial hospital for a follow-up bone aspiration now? I would like to ask Dr. Liu to reply to the above 3 questions in his busy schedule. Liu Jiajun, Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University: Hello! Your reply is as follows: 1. Under normal circumstances, the number of megakaryocytes that can be seen in a bone marrow film is usually 7-35, and the number of megakaryocytes in your bone marrow is 89, which is slightly higher than normal (some normal people can also be). Therefore, I personally think that your bone marrow is basically normal. 2, from the blood routine and bone marrow examination, there is no evidence of blood disease. 3.Blood routine is generally a machine-operated test, and some indicators may be slightly high or low. Your blood routine does not look abnormal at present, and there is no need for bone marrow aspiration examination for the time being. Patient: Thank you for your reply, very professional and instructive, hats off to you! As you mentioned in your reply, under normal circumstances, the number of megakaryocytes that can be seen in a bone marrow film is usually 7-35, and your bone marrow megakaryocytes are 89, which is slightly higher than normal (some normal people can also be). Therefore, I personally think that your “bone marrow is basically normal.” I also consulted with our local hematologist, and her answer to me was: “It could be due to the size of the smear during the smear, maybe the smear was slightly too large, resulting in a high number of megakaryocytes seen in the smear”. I am now much relieved and thank you again! I will consult you again if I have any unclear questions in the future, thank you! Liu Jiajun, Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University: Hello! Don’t be polite, health is better than everything! Patient: Dear Dr. Liu, how are you? I am a patient who has consulted with you before. I have received a lot of help from you, thank you very much. But my body has not improved, and my symptoms have not been relieved, there are a few questions I would like to consult you, I hope you can give answers. 1, I tested the T lymphocyte subpopulation, the result is CD4 436, CD8 531, the ratio of 0.82, and I regularly observed the blood routine for four months, there are several changes in the situation is as follows: white blood cells 6.61-6.34-6.12-5.74, lymphocyte percentage: 31.4%-34.3%-30.6 34.3%-30.6%-37.4%, monocyte percentage: 4.2%-5.2%-7.5%-7.4%, neutrophil percentage: 55.4%-54.1%-50.5%-43.6%, eosinophil percentage: 6.0%-7.8%-11.0%-11.1%, and other tests have not changed significantly. The changes in other tests are not obvious. Dr. Liu, are the T-lymphocyte subsets and blood changes typical of a viral infection? 2. Because I had high-risk behavior more than 6 months ago, the symptoms and the time of symptoms were more like HIV, so I thought I was infected with HIV at first, but I was tested for HIV antibodies in four weeks, six weeks, three months and six months respectively, and the method was Abbott Rapid + Enzyme Assay. The local doctor said that HIV was completely ruled out, but my symptoms are very similar to HIV and are typical and severe, and now my loved one also has a stuffy nose, dry cough, chronic low fever (37.2°, it used to be around 36°) swollen lymph nodes in the neck (2CM), rash, drowsiness, severe hair loss, red eyes and some other symptoms typical of HIV. I heard that there are cases of undetectable HIV. Could my lover and I be infected with undetectable HIV? 3, now very confused, to the hospital test and what can not be found, do not know what to do, please now I want to go to the hospital test, then to do what test items are more realistic, and what virus or bacterial infection caused by the symptoms and HIV is very similar to it, please Dr. Liu help out attention? I would like to ask Dr. Liu to answer the above questions in his busy schedule, thank you. Liu Jiajun, Department of Hematology, The Third Affiliated Hospital of Sun Yat-sen University: HIV mainly destroys the immune system of the human body. After the immune system of the human body is destroyed by HIV, it loses the ability to resist various pathogens that destroy the human body, and finally develops a variety of secondary infections or diseases such as tumors. Initially, HIV infection may not be detected by serological examination because HIV infection can go through a window period, during which flu and other cold symptoms can appear initially, and then other disease manifestations gradually appear. The window period is the time between being infected with HIV and the production of a sufficient amount of a specific antibody that can be detected in the body. The window period is usually 2 weeks to 3 months, and occasionally up to 5-6 months, with the average length being 3 months. You have been tested several times and no antibodies have been produced, so the probability of HIV infection is not high. Your T-lymphocyte ratio is normal, so there is no need to worry. In addition, a slightly high eosinophil count should be checked for allergic changes caused by allergic factors, etc. If you have symptoms such as enlarged lymph nodes and low fever, you can be checked for rheumatic diseases, tuberculosis, and infections from certain viruses such as EBV. In a sense, “suspicion is more important than the actual disease”, I often encounter friends like you in the clinic, many times mainly from their own speculation and uneasiness, and sometimes they are too shy to speak up, or even from the network propaganda “allopathy into the seat” The more they look at it, the more they feel that they are this kind of patient, thus generating fear and depression, and even affecting their normal life and work.