摘要
目的提高对川崎病静脉应用丙种球蛋白(IVIG)后发生溶血性贫血的认识,有利于早期诊断和合理治疗。方法回顾性分析我院1例川崎病应用IVIG后发生溶血性贫血病例,并检索2000年1月1日-2020年12月31日共20年的国外文献进行复习。结果1例3岁男性患儿在应用4g/kg IVIG后发生溶血性贫血,血红蛋白最低降至78g/L。给予患儿指导随访,出院12d复查血红蛋白升至113g/L。检索国外文献,符合本文纳入及排除标准病例报告共32例。结果发现溶血多发生在应用IVIG后4d内,年龄分布在2月~16岁,以3~6岁儿童居多。其中男性(62.5%)、A型血(50%)及应用4g/kg IVIG(78%)的患儿易发生溶血。72%的患儿需要接受输血或激素治疗。结论川崎病应用IVIG后出现进行性贫血、与川崎病病程不一致时,需要注意溶血性贫血。其发生溶贫的高危因素包括非O型血、大剂量IVIG(包括二次输注)、肥胖、自身过度炎症反应。该并发症预后良好。
Objective To improve the recognition of hemolytic anemia after intravenous immunoglobulin(IVIG)in Kawasaki disease,and to make early diagnosis and reasonable treatment.Methods A case of Kawasaki disease complicated with hemolytic anemia after IVIG in our hospital was analyzed retrospectively,and the foreign literatures from January 1,2000 to December 31,2020 were searched for review.Results A 3-year-old boy developed hemolytic anemia after 4g/kg IVIG,and the lowest hemoglobin was 78g/L.After 12 days of discharge,the hemoglobin level rose to 113g/L.According to the inclusion and exclusion criteria,32 cases were reported.It was found that hemolysis mostly occurred within 4 days after IVIG,and the age ranged from 2 months to 16 years old.Most of them were children aged 3~6 years old(68.8%).Male(62.5%),type A blood(50%)and 4 g/kg IVIG(78%)were prone to hemolysis.72%of the children needed blood transfusion or hormone therapy.Conclusion It is necessary to pay attention to hemolytic anemia in Kawasaki disease patients with progressive anemia after IVIG.The high risk factors of aplastic anemia include non-O type blood,high-dose IVIG(including secondary infusion),obesity and excessive inflammatory reaction.Good prognosis.
作者
冀青
郭兴青
柏翠
聂娜娜
毛成刚
JI Qing;GUO Xingqing;BAI Cui;NIE Nana;MAO Chenggang(Qingdao University,Qingdao 266071,China;Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《济宁医学院学报》
2021年第4期300-304,共5页
Journal of Jining Medical University
关键词
川崎病
丙种球蛋白
溶血性贫血
Kawasaki disease
Gamma globulin
Hemolytic anemia
