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1 病例介绍患者女,37岁,因进行性头晕、乏力、面色苍白2个月余,于1991年4月14入院.无化学毒物接触史.查体:T36.4℃,P100次/分,R18次/分、BP13/9kPa.重度贫血貌.针刺部位皮肤可见瘀斑、浅表淋巴结肿大.无胸骨压病.心肺无异常.腹平坦,肝肋下4.0cm.质地中等硬.脾来触及.实验室检查:Hb45g/L,WBC2.9×10~9/L、分叶0.06,淋巴0.94,BPC30×10~9/L,Ret0.001.乙型肝炎血清标记HBsAg等五项(HBV—M)均阴性.入院后骨髓检查:髂后上棘、髂前上棘、胸骨骨髓涂片检查均示增生极度低下,以淋巴细胞为主,幼红、幼粒细胞罕见;巨核细胞未见.骨髓病理切片示:增生极度低下,可见淋巴细胞、浆细胞和肥大细胞,难以找见粒、红两系细胞,可见2个胞浆不甚丰富的巨核细胞、纤维组织增生.诊断:再生障碍性贫血(AA).治疗经过:入院后第3天出现右肘窝针刺部位化脓性感染,高热.病情进行性加重,右肘窝感染灶逐渐扩大,高热持续并出现进行性周身皮肤黄疸及多部位紫癜和淤斑,肉眼血尿,BPC进行性降低.右肘窝脓汁培养及血培养结果均为金黄色葡萄球菌生长.试管法凝血时间为15分钟(正常对照7分钟).凝血酶原时间为21.5秒(对照16.2秒),乙醇胶试验阳性、确诊为金黄色葡萄球菌败血症并弥漫性血管内凝血(DIC).给予小剂量肝素抗凝治疗并积极抗感染,输血等
1 case description Female, 37 years old, due to progressive dizziness, fatigue, pale more than 2 months, admitted to hospital on April 14, 1991. No history of exposure to chemical toxins. Physical examination: T36.4 ℃, P100 beats / R18 beats / min, BP13 / 9kPa. Severe anemia appearance .Acupuncture site of the skin can be seen ecchymosis, superficial lymph nodes .No sternal pressure disease .No abnormal heart and lung .Flat flat, liver ribs 4.0cm. Medium texture. Spleen (Hb45g / L, WBC 2.9 × 10-9 / L, leaf 0.06, lymph 0.94, BPC30 × 10-9 / L, Ret0.001. Hepatitis B serum HBsAg and other five HBV-M) were negative.After admission bone marrow examination: posterior superior iliac spine, anterior superior iliac spine, sternal bone marrow smear examination showed extremely low proliferation, mainly lymphocytes, young red, promyelocytic rare; megakaryocytes See bone marrow biopsy showed: hyperplasia is extremely low, showing lymphocytes, plasma cells and mast cells, it is difficult to find grain, red two lines of cells, we can see two cytoplasm is not rich in megakaryocytes, fibrosis. Diagnosis: regeneration Obstructive anemia (AA) .After treatment: on the 3rd day after admission, there appeared purulent infection of the acupuncture area in the right elbow, high fever, progressive aggravation of the right elbow fossa, , High fever continued and the emergence of progressive peritumoral skin jaundice and multiple sites of purpura and ecchymosis, gross hematuria, BPC progressive reduction of the right elbow fist pus culture and blood culture results were Staphylococcus aureus growth. (Normal control 7 minutes) Prothrombin time was 21.5 seconds (control 16.2 seconds), alcohol gel test was positive, confirmed as Staphylococcus aureus septicemia and diffuse intravascular coagulation (DIC) given low-dose heparin anticoagulant therapy And active anti-infection, blood transfusion