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男孩,6岁半。入院前两月余剑下隐痛,尿色加深。后黄染骤然加重,尿色茶样。发热数日,T38～39.5℃。面色渐由黄变白,神萎乏力,尿少,腹围增加,双下肢凹性水肿,活动后心累、气促。区医院考虑“甲肝”。后个体医诊断“肝腹水”,投予克尿噻等近一月。水肿减轻,但倦怠、软弱日重,恶心呕吐,食欲减退,面色、结膜苍白如纸。入院前夜神志丧失10余分钟。入院查:T.38.4℃.P.140次/分,R.32次/分,BP12/6kPa。重度贫血貌。轻度黄染、浮肿。频咳,双肺少许干鸣音。心前区Ⅱ一Ⅲ级缩鸣。Hb25g/L,WBC3.4×109/L,Plt50×109/L。RC为0。RBC形态正常,未见破碎RBC。血钠117.8mmol/L;CO_2—CP18.23mmol/L。肝功、渗透脆性试验正常。HBsAg、血培养、Ham和Coomb’s试验均阴性。Hp1.7g/L。入院后T.37.3～39℃。输血当晚起连续高热40～42℃,黄染加深。
Boy, 6 and a half years old. Yu Jian under the two months before admission, pain, dark urine. Suddenly increased after the yellow dye, urine-like tea. Fever days, T38 ~ 39.5 ℃. Gradually pale yellow to pale, Shenwei fatigue, oliguria, abdominal circumference increased, both lower extremity concave edema, tired heart activities, shortness of breath. District Hospital to consider “hepatitis A”. After the individual diagnosis of “liver ascites”, urinary thiazide and other nearly January. Edema to reduce, but fatigue, weakness, nausea, vomiting, loss of appetite, complexion, pale, such as paper. On the eve of admission lost consciousness more than 10 minutes. Admission check: T.38.4 ℃ .P.140 times / min, R.32 times / min, BP12 / 6kPa. Severe anemia appearance. Mild yellow dye, edema. Frequent cough, lungs a little dry sounds. Premenstrual Ⅱ Ⅱ Ⅲ grade Ming Ming. Hb25g / L, WBC3.4 × 109 / L, Plt50 × 109 / L. RC is 0. RBC morphology is normal, no broken RBC. Serum sodium 117.8mmol / L; CO_2-CP18.23mmol / L. Liver function, osmotic fragility test is normal. HBsAg, blood culture, Ham and Coomb’s test were negative. Hp1.7g / L. After admission T.37.3 ~ 39 ℃. Continuous high fever from the night of transfusion 40 ~ 42 ℃, yellow dye deepened.