临床药师对一例阿司匹林联合阿托伐他汀致药物氧化性溶血性贫血的干预

Clinical pharmacist's intervention in a case of drug-induced oxidative hemolytic anemia resulting from the combined use of aspirin and atorvastatin

目的临床药师对1例阿司匹林联合阿托伐他汀致药物氧化性溶血性贫血的临床表现及机制进行分析,探讨溶血性贫血发生过程中的监护策略以及临床药师在临床治疗中能够发挥的作用。方法临床药师通过对实际病例的深度分析,并利用Naranjo评分关联评价,同时综合中国知网、万方数据、PubMed、Embase数据库文献资料,总结此类不良反应的特点、发病机理、潜伏期及应对措施及其效果。结果临床药师发现1例溶血性贫血患者的红细胞破坏及骨髓代偿现象,并确证双药联用风险;文献研究揭示了平均红细胞体积分布宽度(RDW)动态变化规律,结合实际病例治疗效果,证实两药联用可能影响炎症因子表达并参与药物氧化性溶血性贫血(DOHA)发病机制。结论临床药师在识别和处理阿司匹林与阿托伐他汀联用导致的罕见DOHA不良反应中起到核心作用,尤其对于用药后短期内出现、停药后迅速缓解的情况。面对这类事件,药师应指导紧急停药,并安排全面实验室检查(血常规、尿常规、肝功能及网织红细胞计数等),考虑葡萄糖-6-磷酸脱氢酶(G6PD)基因检测以便个性化制定治疗方案。同时,强化对G6PD缺乏患者的用药教育以及定期监测相关生物标志物是保障高风险患者安全用药的关键措施。

Objective The clinical pharmacist analyzes the clinical manifestations and mechanisms of drug-induced oxidative hemolytic anemia caused by the combined use of aspirin and atorvastatin,exploring the surveillance strategies during the development of hemolytic anemia and the role a clinical pharmacist can play in the clinical treatment process.Methods The clinical pharmacist conducted a deep analysis of an actual case and utilized the Naranjo Adverse Drug Reaction Probability Scale to evaluate the association.Additionally,synthesized literature data from databases such as China National Knowledge Infrastructure(CNKI),Wanfang Data,PubMed,and Embase to summarize the characteristics,pathogenesis,latency period,management strategies,and outcomes of this type of adverse reaction.Results In one case of hemolytic anemia,the clinical pharmacist observed red blood cell destruction and compensatory bone marrow hyperplasia,and confirmed the potential risk associated with dual-drug therapy.Literature research further revealed the dynamic changes pattern of RDW,and combined this with the therapeutic outcome in the present case,it confirmed that the co-administration of these two drugs may influence the expression of inflammatory factors and potentially participate in the pathogenesis of DOHA(Drug-Induced Oxidative Hemolytic Anemia).Conclusion Clinical pharmacists play a pivotal role in identifying and managing rare DOHA adverse reactions caused by the combined use of aspirin and atorvastatin,particularly for cases that appear shortly after drug initiation and resolve rapidly upon discontinuation.When encountering such events,pharmacists should advise on immediate cessation of the medication and arrange for comprehensive laboratory tests,including complete blood count,urine routine,liver function tests,and reticulocyte counts,and consider G6PD gene testing is also recommended for personalized treatment planning.Moreover,reinforcing patient education about medication use in G6PD-deficient patients and regularly monitoring related biomarkers are critical measures to ensure safe drug use among high-risk patients.