血栓性血小板减少性紫癜二例误诊并文献复习  

Two Misdiagnosed Patients with Thrombotic Thrombocytopenic Purpura:Reports and Literature Review

作　　者：赵妍[1] 孟庆义[2] 

机构地区：[1]解放军总医院重症医学科,北京100853 [2]解放军总医院急诊科,北京100853

出　　处：《临床误诊误治》2013年第8期16-19,共4页Clinical Misdiagnosis & Mistherapy

基　　金：解放军总医院科技创新苗圃基金(11KMZ04)

摘　　要：目的探讨血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)的临床特点及误诊原因。方法对2例TTP的误诊资料进行回顾性分析。结果 1例以发热、肝肾功能损害入院,另1例以头晕、头痛、低热及双下肢淤斑入院。入院经相关检查,例1初诊为药物性肝、肾功能损伤,例2初诊为头痛及血小板、血红蛋白减少原因待查等,予相应治疗未见好转,很快出现意识障碍、休克,病情进展迅速,再次行相关医技检查,最终经多学科会诊综合分析确诊为TTP。2例确诊后均放弃治疗,后失访。结论 TTP临床易误诊,临床医生应提高对本病的认识,遇有血小板减少、微血管病性溶血性贫血、发热、神经精神症状、肾功能损害表现者应警惕TTP的可能。Objective To discuss clinical characteristics and misdiagnosis cause of thrombotic thrombocytopenic purpura（TTP）.Methods Clinical data of 2 misdiagnosed patients with TTP were retrospectively analyzed.Results One patient was admitted for fever,and functional lesion in liver and kidney,while the other was admitted for dizziness,headache,low-grade fever and ecchymosis in both lower extremities.The first one was diagnosed as having functional injuries in liver and kidney induced by drugs,and the other was diagnosed as having a headache and reduction of platelets and hemoglobin with further examination for causes by admission examinations.Patients＇condition did not improve by corresponding treatment,consciousness disorders,shock,and rapid developmental pathogenetic condition appeared soon after admission.TTP was confirmed by more correlated medical examinations and multidisciplinary consultations.The two patients gave up further treatment after final diagnosis and lost follow-up.Conclusion TTP may be easily misdiagnosed or missed diagnosis,so clinician should enhance awareness of this disease,and TTP should be considered in the patient with thrombocytopenia,microangiopathic hemolytic anemia,fever,neuro-psychiatric symptoms,and renal functional lesion.

关 键 词：紫癜 血栓性血小板减少性 误诊 药物性肝炎 脑梗死 

分 类 号：R554.6[医药卫生—血液循环系统疾病]