儿童风疹并溶血性贫血7例

Hemolytic anemia following postnatally acquired rubella in 7 cases of children

目的 探讨儿童风疹并溶血性贫血临床特点 ,提高对此病认识。方法 结合文献资料对 7例儿童风疹并溶血性贫血临床资料进行回顾性分析。结果 7例均为学龄儿童 ,在风疹症状出现后 2～ 4d并溶血性贫血 ;血风疹病毒抗体IgM均阳性。其中 4例直接Coomb′s试验和 (或 )红细胞抗体阳性 ;并呈重度贫血 ;诊断为自身免疫性溶血性贫血 (AIHA) ,给予激素、人血丙种球蛋白 (丙球 )、输血治疗后病情好转。 3例直接Coomb′s试验和红细胞抗体阴性并呈中度贫血 ,仅予抗病毒治疗后病情好转。随访 1年均无复发。结论 儿童风疹并溶血性贫血很少见 ,当并AIHA时 ,应加用激素、丙球治疗 ,必要时予输注洗涤“O”型红细胞。

Objective To study the clinical characteristics of children′s hemolytic anemia following postnatally acquired rubella, and to improve the understanding of the disease. Methods The clinical materials of 7 children with hemolytic anemia following postnatally acquired rubella were analyzed, combined with the review of related literatures.Results Seven patient′s clinical symptoms of hemolytic anemia occurred 2 to 4 days from the onset of rubella′s symptoms, and the serum anti-rubella immunologlobin M(IgM) was all positive. Direct Coomb′s test and/or erythrocyte antibody was positive in 4 cases, and the anemia was of severe degree. They were diagnosed as autoimmune hemolytic anemia(AIHA) and treated with corticosteroid and intravenous immunologlobin(IVIG) and blood transfusions, and the severity of anemia gradually abated. Direct Coomb′s test and erythrocyte antibody was negative in three of the 7 cases tested with moderate anemia. Anti-virus therapy was administered and the hemoglobin level gradually returned to normal. We considered that hemolytic anemia of this 3 cases was direct destruction of RBCs by the rubella virus. During the 1 year follow-up, there was no relapses.Conclusions Hemolytic anemia is a very rare complication of rubella virus infection in children. When it is complicated with AIHA, we should administer corticosteroid and IVIG treatment for the AIHA in these patients, and patients with severe anemia require washing type 'O' red blood cell for transfusion. If adequate treatment is given, the prognosis for this complication appears to be benign one in children.