血浆置换以及大量血浆输注导致终末期肝病患者溶血性贫血分析

Analysis of plasma exchange or infusion induced hemolysis in end-stage patients with liver disease

目的分析人工肝血浆置换频繁或血浆输注后导致终末期肝病患者溶血性贫血的临床特点,探讨有效的治疗方法。方法收集2003年3月到2007年12月共106例在血浆置换或血浆输注后出现非出血性贫血或贫血加重的终末期肝病患者的临床资料,分析统计贫血的临床表现、形态学特征、实验室检查特点和骨髓的特点,观察停止血浆使用后贫血改善的情况。结果所有病例中,66例(62.26%)患者有乏力表现,9例(8.49%)患者有心悸症状,43例(40.57%)患者有发热表现,79例(74.53%)患者有黄疸加深表现,3例(2.83%)患者有一过性腰痛,13例(12.26%)患者无明显自觉症状。73例(68.87%)患者有血清珠蛋白(Hp)下降;68例(64.15%)患者网织红细胞百分比升高;仅有39例(36.79%)患者Coomb′s试验呈阳性。有9例(8.49%)患者既无Hp的下降,Coomb′s试验也呈阴性,仅仅表现为血红蛋白(Hb)下降。67例(63.21%)患者在停止使用血浆后Hb下降停止,或有所上升。结论终末期肝病患者在频繁输注血浆或者行血浆置换术后,可出现明显的贫血或者贫血加重。

Objective To analyze the feature of hemolysic anemia occurred in patients with end-stage liver disease after frequently plasma exchange or plasma infusion,and explore the effective therapy,in order to impress most doctors.Methods We collected clinical data from 106 cases hospitalized during 2003.3-2007.12 with end-stage liver disease complicated by anemia after plasma exchange or infusion,including clinical symptoms,physical examination,and related lab tests.Analysed the feature of the hemolysis,explored the therapeutic methods of the patients,observed the curative effect.Results Sixty-six cases（62.26%） felt fatigue,9 cases（8.49%） had palpitation, 43 cases（40.57%）suffered fever,79 cases（74.53%）had increased jaundice,3 cases（2.83%）suffered lumbago,13 cases（12.26%）had no symptoms.68.87% of these patients had a descent of Haptoglobin（ Hp）; 68 cases （64.15%） had a ascent of reticulocyte counts;only 39 cases （6.79%） had a positive result of Coomb′s test;9 cases（8.49%） didn′t have any posistive examination results.Hemoglobin of 67 cases（63.21%） raised after ceasing the plasma infusion.Conclusion Regular blood routine test should be taken during the regular plasma exchange or infusion of plasma,because of the high rate of occurrence of hemolysis related to the plasma infusion.The clinic manifestation of the hemolysis could be negative,which sometimes be discovered only by the persist descent of the hemoglobin concentration.The most effective treatment is to cease the use of the plasma,and avoid the use of other blood products as much as possible.