英夫利西单抗诱发再生障碍性贫血

Aplastic anemia induced by infliximab

1例29岁男性患者因克罗恩病给予英夫利西单抗300 mg静脉滴注,首次给药后第4天血常规检查:白细胞计数4.63×109/L,中性粒细胞计数2.39×109/L,血红蛋白144 g/L,血小板计数138×109/L。第2次给药后25 d患者肢体皮肤出现针尖大小紫色瘀点,实验室检查:白细胞计数2.07×109/L,血红蛋白109 g/L,血小板计数10×109/L。给予重组人粒细胞集落刺激因子和重组人血小板生成素,并间断输血,但外周血细胞计数进行性下降。结合骨髓涂片检查和骨髓活检结果,诊断为再生障碍性贫血。给予美罗培南、氢化可的松、促红细胞生成素、环孢素、司坦唑醇、兔抗人胸腺细胞免疫球蛋白、更昔洛韦等治疗。约2个月后复查:白细胞计数2.06×109/L,中性粒细胞计数1.62×109/L,红细胞计数2.51×1012/L,血红蛋白73 g/L,血小板计数24×109/L。患者出院,继续环孢素治疗。次日患者出现发热,7 d后双上肢、背部散在出现紫红色瘀点。患者再次入院,血常规检查:白细胞计数4.59×109/L,中性粒细胞计数3.80×109/L,红细胞计数2.45×1012/L,血红蛋白74 g/L,血小板计数56×109/L。诊断为重型再生障碍性贫血。尽管全力救治,但患者终因重度贫血(血红蛋白降至38 g/L)、重症感染、出血而死亡。

A 29-year-old male patient with Crohn disease received an IV infusion of infliximab 300 mg. On day 4 after the first administration, his routine blood tests showed the following levels： white blood cell count 4.63 × 109/L, neutrophil count 2.39 × 109/L, hemoglobin 144 g/L, platelet count 138 × 109/L. On day 25 after the second administration, he developed pinhead-sized purple petechiae on his skin. Laboratory tests showed the following levels： white blood cell count 2.07× 109/L, hemoglobin 109 g/L, platelet count 10 × 109/L. He received recombinant human granulocyte colony-stimulating factor, recombinant human thrombopoietin and intermittent blood transfusion, but blood cell count fell progressively. Aplastic anemia was diagnosed according to bone marrow smear and bone marrow biopsy. And then he was treated with meropenem, hydrocortisone, erythropoietin, ciclosporin, stanozolol, rabbit anti-human thymocyte immunoglobulin, and ganciclovir. About 2 months later, reexamination showed the following findings： white blood cell count 2.06 × 109/L, neutrophil count 1.62 × 109/L, red blood cell count 2.51 × 1012/L, hemoglobin 73 g/L, and platelet count 24 × 109/L. He was discharged and continued receiving ciclosporin treatment. The patient developed fever on the second day. After 7 days, purplish red petechiae scattered on his upper limbs and back. He was hospitalized again. Routine blood tests showed white blood cell count 4.59 × 109/L, neutrophil count 3.80 × 109/L, red blood cell count 2.45 × 1012/L, hemoglobin 74 g/L, and platelet count 56 × 109/L. Severe aplastic anemia was diagnosed. The patient finally died from severe anemia （ his hemoglobin level decreasing to 38 g/L）, severe infection and hemorrhage despite resuscitation attempts.