头孢哌酮钠舒巴坦钠致儿童急性溶血

Cefoperazone sodium sulbactam sodium-induced acute hemolysis in a child

1例4岁男性患儿因重症肺炎给予头孢哌酮钠舒巴坦钠0.8 g静脉滴注、1次/12 h。治疗第3天,滴注该药约15 min时,患儿出现茶色尿、腹痛、皮肤苍白、四肢发凉,立即停止滴注。实验室检查示红细胞计数1.7×10 12/L(治疗前4.7×10 12/L),血红蛋白67 g/L(治疗前121 g/L),网织红细胞计数0.12,总胆红素54.7 μmol/L,间接胆红素42.4 μmol/L,直接抗人球蛋白试验(Coombs试验)阳性;尿蛋白(++),尿潜血(++),尿胆原(+++),尿红细胞87个/HP。考虑为头孢哌酮钠舒巴坦钠导致的急性溶血,并给予甲泼尼龙静脉滴注及其他对症治疗,抗感染治疗换用注射用阿奇霉素。停用头孢哌酮钠舒巴坦钠第9天,患儿血常规、尿常规恢复正常,直接Coombs试验阴性。

A 4-year-old boy received an IV infusion of cefoperazone sodium sulbactam sodium 0.8g once per 12 hours for severe pneumonia.On day 3 of the treatment,the child developed brown urine,abdominal pain,pale skin,and cold limbs at about 15 minutes of the infusion.Then the infusion was stopped immediately.Laboratory tests showed decreased red blood cell count 1.7×10^12/L(4.7×10^12 before treatment)and hemoglobin 67g/L(121g/L before treatment),reticulocyte 0.12,total bilirubin 54.7μmol/L,indirect bili-rubin 42.4μmol/L,direct Coombs test positive,urine protein(++),urine occult blood(++),urobilinogen(+++),87 urine red blood cells per high power field.The acute hemolysis caused by cefoperazone sodium sul-bactam sodium was considered.The drug was discontinued immediately and IV infusion of methylpredniso-lone and other symptomatic treatments were given.Then the boy's condition gradually improved.The anti in-fection treatment was replaced by azithromyein for inection.On day 9 of cefoperazone sodium sulbactam s0-dium withdrawal,the boy's blood routine and urine routine returned to normal and the direct Coombs test was negative,