尼美舒利致幼儿溶血性贫血

Hemolytic anemia due to nimesulide in a child

1例5岁女性患儿因发热口服其家长自行购买的尼美舒利颗粒50 mg，服药后约16 h出现腹痛及洗肉水样血尿。因发热再次服用尼美舒利颗粒50 mg，服药后约3 h后前述症状复现。实验室检查示外周血白细胞计数 （WBC） 24.5×10^9/L，中性粒细胞计数 （NEU） 14.5×10^9/L，红细胞计数（RBC）1.6×10^12/L，血红蛋白（Hb） 55.0 g/L，血小板计数 （PLT）193×10^9/L。外院诊断为溶血性贫血，给予人免疫球蛋白、地塞米松输液治疗5 d后患儿尿液颜色变浅，RBC升至2.7×10^12/L，Hb升至83.0 g/L。发病第7天入我院，血常规检查示WBC 18.7×10^9/L, NEU 10.5×10^9/L，RBC 2.8×10^12/L，Hb 93.0 g/L，PLT 521×10^9/L，网织红细胞计数 （Ret） 320×10^9/L。给予阿奇霉素抗感染及地塞米松、谷胱甘肽等对症治疗10 d后复查血常规示WBC 17.2×10^9/L， NEU 12.6×10^9/L，RBC 3.5×10^12/L，Hb 114.0 g/L，PLT 575×10^9/L，Ret 150×10^9/L。患儿未再出现血尿。

A 5-year-old girl with fever received nimesulide granules 50 mg which was bought by her parents. Sixteen hours later she developed abdominal pain and gross hematuria. She received nimesulide granules 50 mg again because of fever. About 3 hours later the above-mentioned symptoms recurred. Laboratory tests showed the following values： white blood cell count （WBC） 24.5×10^9/L, Neutrophil count （NEU） 14.5×10^9/L, red blood cell count （RBC） 1.6×10^12/L, and hemoglobin （Hb） 193×10^9/L. She was diagnosed as hemolytic anemia in the other hospital and received the fluid therapy and human immune globulin and dexamethasone for 5 days. Then her urine color turned light, RBC and Hb increased to 2.7×10^12/L and 83.0 g/L, respectively. One day 7 of morbidity she was hospitalized in our hospital. Blood routine examination showed the following values： WBC 18.7×10^9/L, NEU 10.5×10^9/L, RBC 2.8×10^12/L, Hb 93.0 g/L, PLT 521×10^9/L,and absolute value of reticulocyte （Ret） 320×10^9/L. She received azithromycin for infection, and symptomatic treatment （dexamethasone and glutathione）. Ten days later, the blood routine examination showed： WBC 17.2×10^9/L, NEU 12.6×10^9/L, RBC 3.5×10^12/L, Hb 114.0 g/L, PLT 575×10^9/L and Ret 150×10^9/L. Hematuria did not occur again in this patient.