摘要
目的总结"溶血危象"的相关特征,探讨溶血危象的诊断要点。方法对1999年3月至2006年3月入住深圳市人民医院儿科的83例AHA患儿临床资料进行回顾分析,根据以往有关溶血危象的概念中所涉及的各种表现在不同程度AHA的发生情况,对相关实验室检查结果进行评价。结果乏力、苍白、气促、呕吐、酱油色尿、心脏Ⅲ级以上收缩期吹风样杂音及肾功能异常等表现主要见于Hb≤70g/L的患儿,并随溶血程度加重而增多;WBC、BUN和LDH升高也以Hb≤70g/L的患儿改变较为明显,溶血越严重,WBC和LDH升高越明显;血钾、CO2结合力、GPT、网织红细胞计数在不同程度AHA的患儿中差异无显著性意义(P>0.05)。结论溶血危象的诊断要点:(1)确定为AHA。(2)Hb下降至≤70g/L,同时出现面色苍白、呕吐、酱油色尿、气促、心脏Ⅲ级以上收缩期吹风性的杂音和肾功能异常中5种以上的表现时应高度疑诊为溶血危象。(3)如伴有高热、腹痛、血压下降、意识障碍、惊厥、心力衰竭或急性肾功能衰竭表现之一者即可确诊。(4)Hb下降至30g/L以下的极重度AHA,无论患者的表现如何,均可诊断为溶血危象。(5)外周血WBC≥20×109/L和血清LDH≥850U/L有助于溶血危象的诊断。
Objective To summarize key points for the diagnosis of hemolytic crisis （ HC ） by analyzing clinical data of children with acute hemolytic anemia （ AHA ）. Methods Totally 83 children with AHA were studied retrospectively to evaluate clinical features of hemolytic crisis suggested by hematologic specialists based on various degrees of AHA. Results Clinical features varied with degree of hemolysis, fatigue, severe pallor, dyspenea, vomiting, dark urine （ tea colored） , heart murmur and abnormal renal function were major signs and physical findings in the patients with Hb ≤70g/L. There were no significant differences for serum potassium, CO2CP, GPT and reticulocyte count among various degrees of hemolysis （ P 〉 0. 05 ）, but WBC, BUN and LDH increased significantly as deterioration of hemolysis especially for the patients with Hb ≤ 70g/L. Conclusion Key points for the diagnosis of HC are suggested （ 1 ） AHA is demonstrated; （ 2 ） any patient presents with Hb ≤70g/L and at least five clinical findings such as severe pallor, fatigue, vomiting, dark urine, dyspnea, heart murmur and renal dysfunction simutaneniously, a diagnosis of HC is highly suspected; （ 3 ） a definit diagno- sis of HC should be made if the patient has one of following characteristics such as high fever, acute abdominal pain, hypo- tension, unconciousness, convulsion, heart failure or acute renal failure ; （ 4 ） any patient with Hb 〈 30g/L; （ 5 ） WBC ≥20 × 10^9/L and serum LDH ≥850U/L are useful for the diagnosis of HC.
出处
《中国实用儿科杂志》
CSCD
北大核心
2008年第2期109-111,共3页
Chinese Journal of Practical Pediatrics
关键词
急性溶血性贫血
溶血危象
儿童
Acute hemolytic anemia
Hemolytic crisis
Children
