Liu Banxia was extremely worried; if the patient was experiencing a myasthenia gravis crisis, it meant his earlier judgment was not very accurate.

The patient's muscle weakness did not only stem from his recent reckless behavior, nor was it solely caused by anemia.

This implied that the patient had a deeper underlying condition.

When Liu Banxia arrived at the VIP hospital room, the patient's condition was truly not good; Liu Yiqing had already connected him to a ventilator.

"Teacher Liu, shortly after arriving at the ward, the patient's eyelids drooped even more. Even after intubation, the corners of his mouth sagged, and his arms and legs were immobile," Liu Yiqing quickly reported.

"Your observation is accurate; start the neostigmine test," Liu Banxia nodded and moved closer to the patient for a thorough examination.

"Dr. Liu, what's happening to Bei? Didn't you say he was fine?" the patient's mother asked anxiously.

"It seems I underestimated the impact of steroids on his body. Please don't worry; I'll take a closer look," Liu Banxia replied.

He was also somewhat troubled, as the transition from myasthenia gravis to a crisis stage was too rapid.

He spread out all the patient's test reports and inserted the chest and head CT scans onto the film viewer.

"Liu Yiqing, call Doctor Xu over," Liu Banxia said after examining for a while.

Liu Yiqing quickly grabbed the phone and called Xu Hui.

For Liu Banxia, the situation felt quite tricky now.

Less than five minutes later, Xu Hui entered from outside.

"The patient shows anemia and muscle weakness and was brought here as an emergency," Liu Banxia explained.

"Traced to a roughly three-year history of steroid injections, and in the past twenty days, his lifestyle has been quite indulgent, including smoking and drinking habits."

"Myasthenia gravis crisis just occurred, and the neostigmine test has been performed. Here are the test data and scans, take a look," he added.

Xu Hui nodded and also moved to the film viewer to carefully analyze. After reviewing, he frowned as well.

"The causes of a myasthenia gravis crisis are essentially twofold: one is hereditary, and the other is related to autoimmune diseases," Xu Hui said.

"This patient should not have a hereditary history of muscle weakness, so we need to consider the second factor. The second factor includes items like infection, drugs, and environmental-related issues."

"Steroid injection duration is quite long, likely corresponding with anemia and liver damage. The scans show no thymoma or hyperplasia, leukocyte index in blood tests is still normal, and temperature is normal, so can we eliminate infection?"

"Do you also think it's linked to long-term steroid injection?" Liu Banxia asked.

"Currently, we can only consider from these two directions, as environmental factors and infection can be ruled out," Xu Hui responded.

"Moreover, the influence of drugs also affects the endocrine system. We cannot determine his medication frequency and dosage, plus his recent physical exhaustion adds more uncertainty."

"Additionally, myasthenia gravis often accompanies thymus hyperplasia or thymoma; this patient's scans are very clean, so what I can think of is drugs."

"Or perhaps it's the combined effect of drugs and environment; start with neostigmine, it might offer some relief. Then we'll observe. If neostigmine's improvement isn't great, the problem becomes more complex."

"Judging by his physical condition, he seems robust, yet he has a history of steroid injections, thus making it hard to ascertain; actually, my opinion mirrors your initial judgment."

Liu Banxia nodded, going around and returning to the same point.

"Dr. Liu, will Bei just remain lying here?" the patient's father asked.

"You heard our discussion; there are only so many factors that can cause myasthenia gravis," Liu Banxia responded.

"We will adjust based on the myasthenia gravis crisis and do our utmost to identify his true underlying condition."

"If indeed the symptoms are from the combination of steroid injections and recent lifestyle, then we can only consider from a therapeutic standpoint."

"But I also reflected; there's uncertainty. Regarding his physical state, anemia is hard to pinpoint."

"We aren't familiar with his past lifestyle either, so I plan to perform a bone marrow biopsy to explore the cause of erythrocyte reduction."

"This is currently the other symptom besides muscle weakness; without a breakthrough on weakness, the procedure becomes necessary."

"Bone marrow biopsy? Does the biopsy require breaking his bones?" the patient's mother asked worriedly.

"While it's also an invasive procedure, the physical damage is minimal. We only extract a little bone marrow, and it won't adversely affect his body," Liu Banxia assured.

The patient's mother couldn't make up her mind and looked toward the patient's father.

"Dr. Liu, will performing this biopsy help determine Bei's condition?" the patient's father asked.

"Although it won't be entirely conclusive, it can guide us toward a direction. The reduction in red blood cells is something we currently can't pinpoint," Liu Banxia thought for a moment and said.

"Initially, we suspected the reduction in red blood cell production was due to medication effects. His situation has changed now, so we need to continue investigating the case."

"Let's proceed," the patient's father nodded.

"Dr. Liu, we entrust Bei to you. No matter the cost or the tests needed, I just want Bei's illness to be cured."

"Rest assured, we share the same sentiments on this," Liu Banxia nodded.

"Liu Yiqing, start the pre-operative preparations for the bone marrow biopsy. Call someone to assist; the head needs to be positioned forward for prone placement."

Liu Yiqing quickly picked up the phone and began contacting others.

"You're suspecting it's a problem with his own hematopoietic function causing the anemia?" Xu Hui asked.

"I'm not quite sure yet; his condition is too complicated," Liu Banxia said with a bitter smile.

"Steroid injections initially promote red blood cell production, but if administered too long or excessively, they can have a suppressive effect. We also considered the possibility of a thymoma, but the scans are clean."

"If we can determine the underlying cause of the anemia, we will at least have a direction. The thymoma might be small, and our CT might not have detected it."

"That would give us an indication to perform surgical exploration. If it's truly due to excessive medication, there's not much more we can do at this point."

Xu Hui nodded; it indeed is a fairly good approach, following a step-by-step diagnostic method.

However, he also harbored doubts, as if the thymoma already caused myasthenia gravis, there should be some degree of hyperplasia and enlargement visible on the CT.

The patient's situation is too complex with a long history of steroid injections. His personal life is also complicated, and has certainly impacted the endocrine system significantly.

"Teacher Liu, where should the sample be taken from?" Liu Yiqing asked.

"Left posterior superior iliac spine," Liu Banxia replied.

Once the location was determined, Liu Yiqing instructed the nurses to turn the patient over, with one nurse responsible for protecting the patient's head. He is on a ventilator, different from typical patients.

Liu Yiqing then spread the drapes, disinfected, and applied local anesthesia, while Liu Banxia put on gloves and a mask, flexing his hands.

The difficulty level of a bone marrow biopsy is similar to that of a lumbar puncture; Liu Banxia didn't dare to proceed hastily. After exchanging dream space training time, he practiced appropriately.

The sensation in your hands doesn't mean you can act recklessly, as there are variances in the structures and cavities of different parts.

The patient is of a burly build, and Liu Banxia adjusted the setting by two millimeters more than usual. Upon feeling a void in his hands, Liu Banxia attached the syringe and drew out bone marrow fluid.

It was his first operation on the patient, and throughout the process, his hands were steady.

However, such an operation is hard for the patient's family to accept easily. The couple now held each other's hands, their faces tense.

"Make a direct smear and inform the laboratory for urgent processing," Liu Banxia said.

Once received, Liu Yiqing quickly started the operation. This task was relatively simple; after preparing the smear, she ran out directly.

"It's done now; I'll apply pressure for a while, and there won't be any bleeding. It won't impact his body," Liu Banxia said.

"Dr. Liu, do you think Bei's condition is hereditary? We don't have such illnesses," the patient's father asked.

"I can't say for sure yet, but the likelihood of it being hereditary is very small," Liu Banxia said. 𝙛𝓻𝒆𝒆𝒘𝙚𝓫𝙣𝙤𝒗𝙚𝓵.𝙘𝙤𝙢

"Smear tests are quick; we'll identify the issue with the red blood cells soon. Discussing anything else now is pointless and might only worry you."

The patient's father nodded; he didn't understand much, but the mention of urgent processing by Liu Banxia and Liu Yiqing's actions reassured him greatly.

He considered transferring the hospital but thought better of it; given the current situation, transferring could possibly mean a round of new tests.

What else can he do? He must choose to trust Liu Banxia's reputation and medical skills to help find his son's diagnosis.

He felt a bit guilty, regretting the lack of discipline towards his son before. He was unaware of the three years of medication use.