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1 临床资料 患儿男性,5岁,广东电白籍,自1994年3月起全身皮肤无明显诱因出现散在瘀斑,齿龈出血,伴面色进行性苍白,乏力,懒动。9月在茂名市人民医院骨髓穿刺,诊断为“造血功能不全”,住院10余天,输血2次,症状未缓解而出院。10月在湛江海军医院诊断为“再生障碍性贫血(AA)”,住院8d,输血2次,输血后皮肤出血点明显增加。以后在当地服中药治疗,症状进行性加重。入院前一周开始发热,体温最高达39℃,伴咳嗽,于1994-12-09首次入我院。入院时重度贫血貌,全身皮肤及粘膜散在出血点及瘀斑,浅表淋巴结不肿大,双肺呼吸音粗,心界略向左下扩大,心率138次/分,律齐,肝脾未触及。血常规:Hb18g/L、RBC0.36×10~(12)/L,WBC2.1×10~9/L、N0.21、L0.79,Ret0.3％,PLT15×10~9/L;骨髓增生明显减低,粒系占45％,成熟中性粒细胞占34.5％,红系占10％,未见巨核细胞,血小板极少见,脚片提示双下肺感染,贫血性心脏损害。诊断:重型再生障碍性贫血Ⅱ型(SAA-Ⅱ);支气管肺炎。
1 Clinical data Children, 5 years old, Guangdong electric Bai Ji, since March 1994 there was no obvious incentive for systemic skin scattered ecchymosis, bleeding gums, with pale complexion, fatigue, laziness. September bone marrow puncture in Maoming People’s Hospital, diagnosed as “hematopoietic dysfunction”, hospitalized for more than 10 days, transfusion 2 times, the symptoms were not relieved and discharged. October in Zhanjiang Naval Hospital diagnosed as “aplastic anemia (AA)”, hospitalized 8d, transfusion 2 times, the skin bleeding after transfusion increased significantly. After serving Chinese medicine in the local treatment, the symptoms worsen. One week before admission, the patient started to have fever. The body temperature reached 39 ° C with cough and entered our hospital for the first time in 1994-12-09. Severe anemia on admission, systemic skin and mucous membranes scattered bleeding spots and ecchymosis, superficial lymph nodes does not enlarge, lung breath sounds coarse, the heart slightly expanded to the lower left, heart rate 138 beats / min, law Qi, liver and spleen not touched . Blood: Hb18g / L, RBC0.36 × 10 ~ (12) / L, WBC2.1 × 10 ~ 9/L, N0.21, L0.79, Ret0.3%, PLT15 × 10 ~ 9 / L; Myeloid hyperplasia was significantly reduced, accounting for 45% of the granulocytes, mature neutrophils accounted for 34.5%, erythroid accounted for 10%, no megakaryocytes, platelets are rare, foot tips double lung infection, anemia, heart damage. Diagnosis: Severe Aplastic Anemia Type Ⅱ (SAA-Ⅱ); Bronchial pneumonia.