Evans综合征一例误诊分析  

Misdiagnosis Analysis of Evans Syndrome

作　　者：郭晓[1] 郭宏谋[1] 孙宇[1] 

机构地区：[1]解放军白求恩国际和平医院血液科,石家庄050082

出　　处：《临床误诊误治》2012年第1期14-17,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省科学技术研究与发展指导计划资助项目(072761183)

摘　　要：目的探讨Evans综合征(evans syndrome,ES)的临床特点、误诊原因,并提出防范对策。方法回顾分析我院收治1例ES误诊的临床资料。结果患者因间断乏力、左下肢疼痛3个月,腹痛1周入院。病程早期于外院及我院均误诊为骨髓增生异常综合征。予相应治疗患者腹痛症状消失,但肝脾无明显缩小。1周后又出现腹部胀痛,再次行相关实验室检查并综合分析确诊为ES。予泼尼松治疗1周后患者贫血明显改善,腹痛消失,乏力显著减轻;2周后血常规、骨髓象检查均恢复正常,临床治愈出院,泼尼松逐渐减量。结论 ES临床表现为贫血、出血、黄疸、肝脾大,实验室检查呈红细胞破坏过多征象。早期溶血不明显、骨髓象改变不典型是造成ES误诊的主要原因。Objective To explore the clinical features, cause of misdiagnosis cause and preventive measures of Evans syndrome （ES）. Methods Retrospective analysis of clinical data of one case of ES misdiagnosis was made. Results The patient was admitted for intermittent weakness, left leg pain for three months, abdominal pain for 1 week. Early in the course of the disease, the patiente was misdiagnosed as having myelodysplastic syndrome. Abdominal symptom disppeared after appropriate treatment but liver and spleen were not significantly reduced. One week later abdominal pain reappeared. The diagnosis of ES was defined after the relevant laboratory tests and clinical feature analysis. After prednisone treatment, anemia was significantly relieved and abdominal pain, and fatigue were not significantly reduced 1 week later; the blood, bone marrow examinations were normal, and the patient was clinically cured with prednisone tapering after 2 weeks. Conclusion ES clinical manifestations of anemia, bleeding, jaundice, hepatosplenomegaly, laboratory tests reveal excessive destruction of red blood ceils. ES misdiagnosis caused by hemolysis is not obvious and bone marrow changes is not typical early in the course of the disease.

关 键 词：EVANS综合征 贫血 溶血性 自身免疫性 误诊 骨髓增生异常综合征 骨髓增殖性疾病 

分 类 号：R556.69[医药卫生—血液循环系统疾病]