摘要
本文报道1例以全身散在瘀斑为主要临床表现的新生儿同族免疫性血小板减少性紫癜病例。患儿因“生后发现全身散在瘀斑30 min”于2022年3月30日收治于南方医科大学南方医院。入院后血常规示血小板计数5×109/L,伴白细胞减少、血红蛋白降低及肝大,但凝血功能正常。予输注随机血小板及静脉注射人免疫球蛋白治疗,效果不佳。治疗前预留血标本送检血小板抗体提示血小板抗体阳性(3+),进一步完善患儿及其母血小板抗体分型提示人类白细胞抗原抗体阳性,确诊为人类白细胞抗原介导的新生儿同族免疫性血小板减少性紫癜,予输注人类白细胞抗原阴性血小板后,全身瘀斑消退,复查血小板计数恢复正常,生后14 d出院。生后29 d头颅MRI提示少许硬膜下积血,6月龄复查血小板正常,2岁半生长发育评估良好。
This report described a case of neonatal alloimmune thrombocytopenic purpura presenting with generalized petechiae.The infant was admitted at Nanfang Hospital,Southern Medical University on March 30,2022,following detection of wide spread petechiae 30 minutes post-delivery.Blood tests revealed severe thrombocytopenia(platelet count 5×10^(9)/L)with leukopenia,decreased hemoglobin,and hepatomegaly,though coagulation function remained normal.Initial treatments—random donor platelet transfusion,and intravenous immunoglobulin—proved ineffective.Pretreatment blood samples showed strongly positive platelet antibodies(3+).Further typing confirmed human leukocyte antigen(HLA)antibodies in both infant and mother,establishing HLA-negative neonatal alloimmune thrombocytopenia.HLA-negative platelet transfusion resolved petechiae and normalized platelet counts,enabling discharge on postnatal day 14.Subdural hemorrhage was detected on MRI at day 29.Platelet levels remained normal at six-month follow-up,with age-appropriate development confirmed at 2.5 years.
作者
林丽莎
郭丽珊
宋小燕
吴伟彬
江林梅
陈红武
王启琼
Lin Lisha;Guo Lishan;Song Xiaoyan;Wu Weibin;Jiang Linmei;Chen Hongwu;Wang Qiqiong(Department of Neonatology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《中华围产医学杂志》
北大核心
2025年第8期682-688,共7页
Chinese Journal of Perinatal Medicine
基金
广州市科技计划项目(2023A04J2301)
