美罗培南致重度血小板减少症1例

A case of severe thrombocytopenia caused by meropenem

1例87岁男性患者,因“头晕、无力、言语不清伴发热5 h”于2019年8月11日收入我院,入院后完善相关检验检查,诊断为脑梗死、双肺多发感染。给予哌拉西林钠他唑巴坦钠、硫酸氢氯吡格雷以及注射用血栓通等药品进行抗感染、抗血小板聚集等对症支持治疗。由于前期抗感染效果不佳,8月18日升级抗感染药物为美罗培南(1 g,q 8 h,ivgtt),8月23日患者PLT 63×10^(9)·L^(-1),皮肤局部紫癜,予停用硫酸氢氯吡格雷、注射用血栓通。8月26日患者PLT下降至14×10^(9)·L^(-1),考虑为美罗培南致血小板减少症,立即停用美罗培南,给予输注血浆、血小板等对症治疗后血小板呈逐渐上升趋势,9月1日PLT为113×10·L^(-1),之后未见血小板减少现象,患者病情稳定后出院。

An 87-year-old male patient was admitted to our hospital on August 11;,2019 due to dizziness,weakness,unclear speech and fever for 5 hours.After admission,relevant tests were completed and he was diagnosed as cerebral infarction and multiple lung infection.Piperacillin sodium/tazobactam sodium,clopidogrel and Xueshuantong for injection were given to him for anti-infection,anti-platelet aggregation and anti-thrombosis.On August 18;,meropenem (1 g,q 8 h,ivgtt) was given to him due to the poor anti-infective effect in the early stage.On August 23;,the blood count of PLT was 63×10^(9)·L^(-1)and he developed local skin purpura.And then clopidogrel and Xueshuantong for injection were stopped.On August 26;,the blood count of PLT decreased to14×10^(9)·L^(-1).The thrombocytopenia caused by meropenem was suspected and meropenem was stopped immediately.After symptomatic treatment such as infusion of plasma and platelets,the blood count of PLT gradually increased.On September 1;,the blood count of PLT was 113×10^(9)·L^(-1).And there was no thrombocytopenia after that.The patient was discharged with a stable condition.