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Objective:To explore the main causes of 50 children with aplastic anemia misdiagnosed as immune thrombocytopenia(ITP), summarize differential diagnosis experience, and provide clinical reference.Methods:According to the diagnostic criteria of aplastic anemia and ITP in children, the initial data of misdiagnosed cases in other hospital admitted to the Department of Pediatrics, Shanghai Tongji Hospital from January 2007 to December 2020, and the results of their re-examination tests in this hospital were analyzed.The causes of misdiagnosis and the main points of differential diagnosis were summarized.Results:Of the 165 children with aplastic anemia treated in the same period, 50 cases (30.3%) had been misdiagnosed as ITP.The main causes of misdiagnosis were summarized as follows.(1) The clinical manifestations in 22 cases disagreed with " typical symptoms of ITP" , and necessary bone marrow examinations were not performed in accordance with the international guidelines to confirm the diagnosis.(2) The bone marrow test results were interpreted falsely.Among 28 patients who underwent the bone marrow smear examination, 6 cases (21%) showed typical aplastic bone marrow, but they were still misdiagnosed with ITP.(3) Patients (15/28 cases, 54%) with atypical bone marrow smears did not receive further bone marrow biopsy to facilitate the diagnosis.(4) In 7 cases (7/28 cases, 25%), their bone marrow examination results met the diagnostic criteria of ITP at initial diagnosis, but no necessary review was performed to verify and correct the diagnosis after glucocorticoid trea-tment failed.Conclusions:Clinical diagnosis should be made in restrict accordance with related disease diagnostic criteria to avoid empirical errors.Diagnosis of ITP requires caution.Especially for those with atypical clinical manifestations or irresponsive to first-line drugs, bone marrow examinations (bone marrow biopsy if necessary) must be performed, and the test results should be correctly interpreted according to the diagnostic criteria to prevent clinical misdiagnosis or missed diagnosis.
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Objective To explore the application value of PBL combined with medical simulation training in pediatric clinical practice for long-schooling program medical students.Methods Totally 41 long-schooling program medical students in pediatric department were taken as study group while 40 medical students as control group.PBL combined with medical simulation training was used in study group while traditional method was used in control group.Teaching effect was evaluated using score analysis,PBL learning performance rating scale and student questionnaire.Results Scores of theory test and clinical skill exam after course completion in study group were significantly higher than those of control group (P ＜ 0.01).PBL learning performance rating scale and student questionnaire showed that the student's comprehensive ability has significantly improved.Conclusions Application of PBL and medical simulation training in the pediatric clinical practice for long-schooling program medical students can enhance students' problem analyzing and summarizing abilities,problem-solving ability and practical operation ability.It can effectively cultivate team collaboration and doctor-patient communication skills as well as improve the quality of teaching.
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10.3969/j.issn.1000-3606.2013.06.007