头孢曲松钠致婴儿溶血性贫血

Ceftriaxone sodium-induced hemolytic anemia in an infant

1例9月龄男婴因发热、咳嗽静脉滴注头孢曲松钠后体温降至正常,但出现面色苍白,哭闹不安,食欲减退。2 d后停用头孢曲松钠,改为肌内注射青霉素,患儿再次出现低热。2 d后血常规检查:血红蛋白67 g/L,红细胞2.95×1012/L,白细胞22.16×109/L,中性粒细胞0.30,淋巴细胞0.60,单核细胞0.07,异性淋巴细胞0.03。给予头孢曲松钠0.9 g入10%葡萄糖注射液100 ml静脉滴注,氨溴索15 mg入莫菲滴管滴注。输液约70 ml时,患儿出现面色苍白、烦躁哭闹,排棕红色尿,呼吸喘促。实验室检查:血红蛋白27 g/L,红细胞1.75×1012/L,网织红细胞0.045;直接抗人球蛋白试验C3 1∶4;尿潜血(+++),红细胞2～8个/HP。立即停用头孢曲松钠,输注红细胞及甲泼尼龙冲击治疗。第6天血常规示血红蛋白111 g/L,红细胞3.83×1012/L,患儿病情好转。

A 9-month-old male infant received an IV infusion of ceftriaxone sodium for fever and cough,and then his temperature normalized.However,he developed facial pale,cry and noisy,and loss of appetite.Two days later,ceftriaxone sodium was replaced with IM penicillin,and the infant experienced low-grade fever again.A further two days later,routine blood tests revealed the following levels： Hb 67 g/L,RBC 2.95×10^12/L,WBC 22.16×10^9/L with neutrophils 0.30,lymphocytes 0.60,monocytes 0.07,and abnormal lymphocytes 0.03.He was administered an IV infusion of ceftriaxone sodium 0.9 g dissolved in 100 ml of 10% glucose,followed by intravenous ambroxol 15 mg via Murphy＇s dropper.After receiving the infusion about 70 ml,the baby suddenly presented with facial pale,cry and noisy,brownish red urine,short of breath.Laboratory testing showed the following values： Hb 27 g/L,RBC 1.75×1012/L with reticulocytes 0.045,Coomb＇s C3 1∶ 4,urine occult blood（＋＋＋）,and urinary RBC 2-8 cells per high power field.Ceftriaxone sodium was stopped immediately.Meanwhile he received RBC transfusions and methylprednisolone pulse therapy.On day 6,routine blood tests showed a Hb level of 111 g/L and a RBC count of 3.83×1012/L.His condition improved.