主任医师:请实习医师先报告病史。实习医师:患者男,45岁。因周身乏力、头昏及鼻衄于五年半前住院,住院期间曾出现黄染并有低热及肝脾肿大,当时血红蛋白5.5g,血小板2.2万,网织红细胞25.4%,Coomb氏试验阳性,经激素治疗症状一度缓解,以后常有间断性黄疸、尿色增深及不规则发热,肌肉酸痛乏力,关节偶疼痛。20余天来胸闷、气短,又觉发热。20余年来双手足遇冷则出现雷诺氏现象,无脱发及光过敏史。过去无肝炎史,无特殊用药史,无类似家族史。体检:T.37.5℃,P.80次/分,全身皮肤色素沉着,以双颊为著,双手指指关节及颜面有局限性萎缩性皮损,双下肢具有网状青斑及毛细血管扩张。全身浅表淋巴结肿大呈黄豆至蚕豆大小,质中,轻压痛。巩膜轻度黄染。颈静脉轻度 Chief physician: ask the intern to report the medical history first. Intern: patient male, 45 years old. Due to weakness, dizziness and epistaxis were hospitalized five and a half years ago, had yellow dye during hospitalization and fever and hepatosplenomegaly, when hemoglobin 5.5g, platelets 22000, 25.4% reticulocytes, Coomb’s test was positive , The hormonal treatment of symptoms once relieved, often after intermittent jaundice, dark urine and irregular heat, muscle soreness, pain even joints. More than 20 days chest tightness, shortness of breath, but also feel fever. For more than 20 years, both hands and feet show cold phenomenon appears Raynaud’s phenomenon, no hair loss and light allergy history. No history of hepatitis in the past, no special medication history, no similar family history. Physical examination: T.37.5 ℃, P.80 beats / min, systemic skin pigmentation, with cheeks as his hands and knuckles and facial limitations have atrophic lesions, both lower extremities with reticular bronchiales and telangiectasias . Systemic superficial lymph nodes was broad bean to broad bean size, quality, light tenderness. Scleral mild yellow dye. Jugular vein mild