抗菌药物诱发急性溶血性贫血临床特点分析

Analysis of clinical characteristics in antibiotics-induced hemolysis anemia

目的:探讨临床常用抗菌药物诱发溶血性贫血的特点。方法:回顾某科发生的头孢唑肟引起溶血性贫血2例患者临床资料,同时在MEDLINE光盘数据库、中国知网中国期刊全文数据库、中国科技期刊全文数据库及万方数据库检索,搜集114例抗菌药物诱发溶血性贫血病例资料,分析其临床及实验室特点。结果:共搜集116例抗菌药物引起溶血性贫血病例,儿童50例,成人66例。报道最多抗菌药物为头孢菌素,其次为青霉素及磺胺类抗菌药物,喹诺酮类及大环内酯类抗菌药物引起溶血性贫血亦有散在病例报道。溶贫发生时抗菌药物应用时间最短为5 min,最长为21 d,69.8%发生在抗菌药物应用1周内。临床症状不典型,表现多样,发热、恶心呕吐、疲劳、腰背疼痛为常见临床表现,常伴有血清白细胞及乳酸脱氢酶明显增高。最常见并发症为肾功能衰竭,其次可有肝功能异常、凝血异常、血小板减少等。42.3%患者出现初始症状及时停药,57.7%患者未及时停药,最终24例死亡。结论:抗菌药物引起溶血性贫血罕见但可致死,及时识别并停药对于改善预后至关重要,临床医师在抗菌药物应用中应随时警惕这一致命性不良反应发生的可能。

OBJECTIVE To explore the clinical characteristics in antibiotics-induced hemolysis anemia(AIHA).METHODS The clinical data of 2 cases of hemolytic anemia induced by ceftizoxime in our department were reviewed.Meanwhile,114 cases of antibiotics-induced hemolytic anemia were collected by searching Pubmed,CNKI,VIP and Wanfang database.We retrospectively investigated and analyzed the clinical materials of the above cases.RESULTS 116 cases of antibiotics-induced hemolysis anemia were collected,including 50 children and 66 adults.The most common antibiotic in the enrolled cases was cephalosporin,followed by penicillinase antibiotic and sulfonamide antibiotic.There are also scattered cases of hemolysis anemia caused by quinolones and macrolides.The shortest AIHA occurring time is 5 minutes after antibiotics treatment,and the longest was 21 days,with 69.8%of cases of AIHA occurred within 1 week of antibiotics treatment.The clinical symptoms were non-specific and various.Fever,fatigue and chill are the common symptoms,often accompanied by significant increase of leucocyte and serum lactate dehydrogenase.The most common complication was renal failure,followed by liver and coagulation abnormality and thrombopenia and so on.The culprit antibiotic was timely withdrew in 42.3%patients,and continued after AIHA occurrence in 57.7%patients.Eventually,24 out of 116 enrolled AIHA patients died.CONCLUSION Hemolytic anemia caused by antibacterial drugs is rare but fatal.Timely identification and drug withdrawal are very important to improve the prognosis.Clinicians should always be alert to the possibility of fatal adverse reactions at any time when antibacterial drugs are used.