Serologic diagnosis of congenital rubella: a cautionary tale.
Serologic diagnosis of congenital rubella: a cautionary tale.
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先天性风疹的血清学诊断：一个警示故事。
DOI：
10.1097/01.inf.0000154366.26705.65
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
D. Hardie
中科院分区：
文献类型：
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作者：
Craig Corcoran;D. Hardie
我们最近治疗了一个患有急性细小病毒感染的男孩。一名14岁的遗传性球形红细胞增多症男孩在休克中被送往医院。他有1周的发热、水样腹泻和呕吐史。到达时，他患了黄疸病，昏昏沉沉。体温38.1℃，心率160/min，呼吸率28/min，血压90/40 mm Hg，血氧饱和度94%。脾肿大，与先前无异。无皮疹，轻度脱水。血色素101 g/L，白细胞计数12.2 109/L（多形核白细胞10.4 109个，带状白细胞0.39 109个，淋巴细胞1.93 109个）。初始网织红细胞计数为300 109/L（正常，10-100 109/L）。静脉pH 7.20，酸中毒，血乳酸3.2 mmol/L（正常，0 ~ 2.4 mmol/L）。有凝血功能障碍的证据：国际标准化比值3.02秒（正常，0.9-1.1秒）；部分凝血活酶时间104秒（正常25-35秒）；肾功能不全血尿素氮28.9 mmol/L（正常2.9 ~ 7.1 mmol/L）；肌酐250 μmol/L（上正常值106 μmol/L）；肝功能障碍天冬氨酸转氨酶389单位/L（正常，0 ~ 36单位/L）；丙氨酸转氨酶78单位/L（正常，0-40单位/L）；未偶联胆红素27 μmol/L（正常0 ~ 17 μmol/L）；偶联胆红素，58 μmol/L（正常，0 ~ 2 μmol/L）。他需要液体复苏，插管和肌力支持。在接下来的48小时内，他的低血压、凝血功能障碍和肾功能改善，并在住院的第三天拔管。在接下来的4天里，出现了贫血（66 g/L），网状红细胞减少（1%）和血小板减少（9 109/L），对血小板输注无反应。瘀点，静脉穿刺处出血
We managed recently a boy with acute parvovirus infection. A 14-yearold boy with hereditary spherocytosis was brought to the hospital in shock. He had a 1-week history of fever, watery diarrhea and vomiting. On arrival, he was jaundiced and lethargic. Temperature was 38.1 C, heart rate 160/min, respiratory rate 28/min, blood pressure 90/40 mm Hg and O2 saturation 94%. Splenomegaly unchanged from previous was present. Rash was absent, and he was mildly dehydrated. Investigations revealed hemoglobin of 101 g/L, white blood cell count 12.2 109/L (10.4 109 polymorphonuclear leukocytes, 0.39 109 band forms and 1.93 109 lymphocytes). The initial reticulocyte count was 300 109/L (normal, 10–100 109/L). He was acidotic with a venous pH of 7.20, and blood lactate was 3.2 mmol/L (normal, 0–2.4 mmol/L). There was evidence of coagulopathy International Normalized Ratio 3.02 seconds (normal, 0.9-1.1 seconds); partial thromboplastin time, 104 seconds (normal, 25-35 seconds); renal dysfunction blood urea nitrogen, 28.9 mmol/L (normal, 2.9-7.1 mmol/L); creatinine, 250 μmol/L (upper normal, 106 μmol/L); and hepatic dysfunction aspartate aminotransferase, 389 units/L (normal, 0-36 units/L); alanine aminotransferase, 78 units/L (normal, 0-40 units/L); unconjugated bilirubin, 27 μmol/L (normal, 0-17 μmol/L); conjugated bilirubin, 58 μmol/L (normal, 0-2 μmol/L).He required fluid resuscitation, intubation and inotropic support. His hypotension, coagulopathy and renal dysfunction improved during the next 48 hours, and he was extubated on the third hospital day. During the next 4 days, anemia (66 g/L) with reticulocytopenia (1%) and thrombocytopenia (9 109/L) unresponsive to platelet transfusion developed. Petechiae, bleeding from venipuncture sites and sub-