临床药师参与1例T-DM1致血小板Ⅳ度降低及其治疗的案例分析

A case analysis of a grade 4 thrombocytopenia induced by T-DM1 and its treatment participated by clinical pharmacist

1例Ⅲ期乳腺癌伴肝转移患者,入院行临床研究T-DM1第3周期治疗,用药后一周出现严重的不良反应:血小板Ⅳ度降低,住院期间血小板最低至2×109·L-1。给予患者rhTPO、rhIL-11、人免疫球蛋白、激素、输注血小板效果均不明显,口服艾曲波帕2个月后,血小板恢复正常。临床药师通过查阅文献对T-DM1导致血小板严重降低进行分析,并对升血小板药物进行归纳总结。

A patient with stageⅢbreast cancer and liver metastasis was enrolled in the clinical study of T-DM1.And the patient was hospitalized for the cycle 3 T-DM1 treatment.A week later,the patient developed gradeⅣthrombocytopenia with the lowest blood platelet count of 2×109·L-1.The blood platelet count didn’t obviously increased after using recombinant human thrombopoietin(rhTPO),recombinant human interleukin 11(rhIL-11),immunoglobulin,hormone and platelets transfusion.The blood platelet count returned to normal range after taking eltrombopag olamine tablets for two months.Clinical pharmacist analyzed severe thrombocytopenia induced by T-DM1 according to literature and summarized platelet-ascending drugs.