儿童再生障碍性贫血被误诊为免疫性血小板减少症主要原因分析  

Main causes of aplastic anemia misdiagnosed as immune thrombocytopenia in children

作　　者：熊婷婷 唐晋清[2] 谢晓恬[2] Xiong Tingting;Tang Jinqing;Xie Xiaotian(Department of Pediatrics,Shanghai Yangpu District Central Hospital,Shanghai 200090,China;Department of Pediatrics,Shanghai Tongji Hospital,Shanghai 200065,China)

机构地区：[1]上海市杨浦区中心医院儿科,上海200090 [2]上海市同济医院儿科,上海200065

出　　处：《中华实用儿科临床杂志》2022年第20期1573-1577,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的归纳曾被误诊为免疫性血小板减少症(ITP)的50例儿童再生障碍性贫血(再障)的主要原因和鉴别诊断经验,以供临床参考。方法参照儿童再障和ITP诊断标准,回顾性分析2007年1月至2020年12月上海市同济医院儿科收治的外院误诊病例的病初资料和本院复诊检测结果,归纳误诊原因和鉴别诊断要点。结果在同期收治的165例儿童再障中,共有50例(30.3%)曾被误诊为ITP。分析归纳主要误诊原因为:1.临床表现不符合"典型ITP",未按照国际指南标准行必要的骨髓检查以明确诊断,共22/50例。2.骨髓检测结果解读有误。在28例初诊行骨髓涂片检查者中,6例(21%)骨髓显示典型再障骨髓象,但仍被诊断为ITP。3.骨髓涂片结果不典型者,未行骨髓活检以助诊断(15/28例,54%)。4.初诊时符合ITP诊断标准,但经糖皮质激素等治疗无效后,未行必要复查以核实诊断(7/28例,25%)。结论临床应严格参照执行相关疾病诊断标准,以避免经验性错误。诊断ITP需要慎重,尤其是临床表现不典型,或一线药物无效者,必须进行骨髓检查(必要时行骨髓活检),并按诊断标准正确解读检测结果,以避免临床误诊或漏诊。Objective To explore the main causes of 50 children with aplastic anemia misdiagnosed as immune thrombocytopenia(ITP),summarize differential diagnosis experience,and provide clinical reference.Methods According to the diagnostic criteria of aplastic anemia and ITP in children,the initial data of misdiagnosed cases in other hospital admitted to the Department of Pediatrics,Shanghai Tongji Hospital from January 2007 to December 2020,and the results of their re-examination tests in this hospital were analyzed.The causes of misdiagnosis and the main points of differential diagnosis were summarized.Results Of the 165 children with aplastic anemia treated in the same period,50 cases(30.3%)had been misdiagnosed as ITP.The main causes of misdiagnosis were summarized as follows.(1)The clinical manifestations in 22 cases disagreed with"typical symptoms of ITP",and necessary bone marrow examinations were not performed in accordance with the international guidelines to confirm the diagnosis.(2)The bone marrow test results were interpreted falsely.Among 28 patients who underwent the bone marrow smear examination,6 cases(21%)showed typical aplastic bone marrow,but they were still misdiagnosed with ITP.(3)Patients(15/28 cases,54%)with atypical bone marrow smears did not receive further bone marrow biopsy to facilitate the diagnosis.(4)In 7 cases(7/28 cases,25%),their bone marrow examination results met the diagnostic criteria of ITP at initial diagnosis,but no necessary review was performed to verify and correct the diagnosis after glucocorticoid trea-tment failed.Conclusions Clinical diagnosis should be made in restrict accordance with related disease diagnostic criteria to avoid empirical errors.Diagnosis of ITP requires caution.Especially for those with atypical clinical manifestations or irresponsive to first-line drugs,bone marrow examinations(bone marrow biopsy if necessary)must be performed,and the test results should be correctly interpreted according to the diagnostic criteria to prevent clinical misdiagnosis or missed

关 键 词：免疫性血小板减少症 再生障碍性贫血 儿童 诊断标准 误诊 

分 类 号：R725.5[医药卫生—儿科]