混合性感染导致患者溶血性贫血的初步研究  

Analysis of the Reasons of Mixed Infection Inducing Haemolytic Anaemia

作　　者：李卉[1] 张晓娟[1] 孙桂香[1] 刘景汉[1] 

机构地区：[1]解放军总医院输血科,北京100853

出　　处：《临床输血与检验》2007年第1期9-11,共3页Journal of Clinical Transfusion and Laboratory Medicine

基　　金："十.五"军队医药卫生科研基金(No01L025)资助

摘　　要：目的初步探讨混合性感染导致患者溶血性贫血的原因。方法追踪1例凝固酶阴性葡萄球菌合并白色念珠菌感染患者,归纳其基础疾病,多次抽取血样测定血常规、肝肾功能及凝血功能,对患者血液进行直接抗人球蛋白试验(DAT)、间接抗人球蛋白试验(IAT),对患者的外周血液和骨髓细胞进行涂片镜检,研究患者贫血的原因。结果住院期间患者的白细胞计数(WBC)、总胆红素(TB)、直接胆红素(DB)、乳酸脱氢酶(LDH)、γ谷氨酰基转移酶(γ-GT)和碱性磷酸酶(ALP)的检测结果出现异常升高,凝血功能障碍,红细胞的DAT试验阳性。细胞涂片见部分红细胞有球形、锯齿形、棘形,细胞膜中间出现点状漏孔;骨髓像显示反应性骨髓细胞形态改变。结论导致患者溶血性贫血的原因可能涉及三方面:(1)机体内环境的紊乱引起氧自由基等因子增加,破坏红细胞膜蛋白的结构;(2)重症肺炎造成肺泡壁毛细血管网毁损,红细胞经过时遭到机械性损害;(3)药物作为半抗原与红细胞黏附,在单核巨噬细胞和K细胞等协同下破坏这些细胞。Objective To explore the reasons of mixed infection inducing haemolytic anaemia. Method One patient, suffered from severe pneumonia, developed mixed infection in lung including Candida albieans and staphylococcus aureus. During the observation period,blood test, liver and kidney function test and coagulation function test were done repetitiously. At the same time, the red blood cells were detected by direct antiglobulin test （DAT）, the antibodies in plasma were also detected by indirect antiglobulin test （IAT）. Morphological changes were observed by peripheral blood and bone marrow smears. Results The white blood cell counts （WBC）,total bilirubin （TB）, direct bilirubin （DB）, lactate dehy- drogenase （LDH）, γ-glutamyltransferase （γ-GT） ,alkaline phosphatase （ALP） of patient were raised remarkably. The disturbance in coagulation mechanism could occur in the patient. DAT was strongly positive. Few RBCs of venous blood of the patient were agglutinated, spherical and ragged at edge. The thorn RBCs and middle-vent-age RBCs could be found. The cells of bone marrow smears showed reactive morphological changes. Conclusion Our results suggested that the possible reasons of haemolytic anaemia are as follows t （1）When the internal milieu was disordered ,free radieals（Fr） and H2O2 can damage the natural molecular morphology of red blood cell membrane surface directly. （2） In acute stage of severe pneumonia,the capillary vessels of patient＇ pulmonary were damaged, which induced the erythrocytes were destroyed mechanically. （3） The antibiotic lead to drug-induced haemolysis by the binding and phagocytosis of monocytes or killer cells.

关 键 词：溶血性贫血 混合性感染 直接抗人球蛋白试验 

分 类 号：R457.1[医药卫生—治疗学]