万古霉素致新生儿速发型血小板减少

Neonatal thrombocytopenia caused by vancomycin

1例出生3 d+16 h男性新生儿因重症感染接受美罗培南(0.136 g、1次/12 h)联合万古霉素(0.05 g、1次/12 h)静脉滴注。治疗前患儿血小板(PLT)116×10^(9)/L;治疗11 h后,PLT降至7×10^(9)/L;加用单采血小板静脉输注,3 d后PLT为32×10^(9)/L。临床药师参与查房时提醒关注万古霉素不良反应,及时监测万古霉素血药浓度。医师考虑血小板减少可能与重症感染有关,加用甲泼尼龙、人免疫球蛋白、冷沉淀凝血因子、单采血小板等。患儿PLT一过性升至121×109/L,此后患儿PLT持续降低。抗感染治疗8 d后,PLT降至30×10^(9)/L,万古霉素血药谷浓度为27.0 mg/L。考虑血小板减少可能与万古霉素有关,药师建议暂时停用该药。停药5 d后,PLT为174×10^(9)/L。

A 3‑day and 16‑hour old male newborn was treated with IV infusion of meropenem 0.136 g once per 12 h combined with vancomycin 0.05 g once per 12 hours for severe infection.The platelet(PLT)was 116×10^(9)/L before treatment and reduced to 7×10^(9)/L after 11 h of treatment.Apheresis platelet by intravenous infusion was added,and PLT was 32×10^(9)/L 3 days later.Clinical pharmacists remind doctors to pay attention to adverse reactions of vancomycin when participating in ward rounds,and monitor the blood concentration of vancomycin in time.The physicians considered that the thrombocytopenia might be related to severe infection,and methylprednisolone,human immunoglobulin,cryoprecipitated antihemophilic factors,apheresis platelet products and etc.were added.The PLT increased to a transient level of 121×10^(9)/L and then continued to decrease.After 8 days of treatment,the platelet PLT decreased to 30×10^(9)/L and the trough concentration of vancomycin was 27.0 mg/L.Thrombocytopenia caused by vancomycin was considered.The pharmacist recommended temporary discontinuation of vancomycin.Vancomycin was stopped,PLT was 174×10^(9)/L 5 days later.