Nhân một trường hợp thiếu máu tan máu do sử dụng cefoxitin=A case of hemolytic anemia due to cefoxitin

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Tác giả: Thị Thanh Nga Hoàng, Quang Tùng Nguyễn, Quang Thịnh Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.569-575

Bộ sưu tập: Metadata

ID: 478325

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Cefoxitin is a secondgeneration cephalosporins antibiotic and commonly used for precaution in surgery. Patients using Cefoxitin may have hemolytic anemia, which is a rare condition but very dangerous, that we need detect early and treat for patients on time. Objectives: Determine the cause of hemolysis and select the appropriate RBCs to transfuse for patients with cefoxitin. Subjects: A patient using Cefoxitin had signs of hemolytic anemia (Hb: 68g/L) and required the red cells transfusion but the pre-transfusion compatibility reaction was positive 3+ in the presence of anti-human globulin. Methods: Case description. Results: Male patient, born in 1956, used Cefoxitin 2g/day, had signs of hemolytic anemia after 1 week. Direct and indirect Coombs tests were positive 3+, the antibody attached to the surface of RBCs was C3d originally. The patient's RBCs eluate reacted with Cefoxitintreated RBCs but not with untreated RBCs. The patient stopped using Cefoxitin and was transfused with 2 red cell units that had a positive 3+ compatibility reaction in the presence of anti human globulin, the transfusion process proceeded normally. After the transfusion, the patient was stable, Hb reached 90g/L. Conclusions: The patient with hemolysis had cause of cefoxitin
the patient stopped using the drug and the transfusion of red cell units was effective.Cefoxitin là kháng sinh thuộc họ Cephalosporin thế hệ 2, được sử dụng phổ biến để dự phòng trong phẫu thuật. Bệnh nhân sử dụng cefoxitin có thể gặp phải tình trạng tan máu, đây là biểu hiện hiếm gặp nhưng rất nguy hiểm nên cần được phát hiện sớm và điều trị kịp thời. Mục tiêu: Xác định nguyên nhân tan máu và lựa chọn chế phẩm khối hồng cầu phù hợp để truyền cho bệnh nhân sử dụng cefoxitin. Đối tượng nghiên cứu: Một bệnh nhân đang sử dụng cefoxitin, có biểu hiện thiếu máu tan máu cần truyền khối hồng cầu nhưng xét nghiệm hòa hợp trước truyền máu dương tính (3+) ở điều kiện có kháng globulin người. Phương pháp nghiên cứu: Mô tả ca bệnh. Kết quả: Bệnh nhân nam, sinh năm 1956, sử dụng cefoxitin 2g/ngày, sau 1 tuần có biểu hiện thiếu máu tan máu. Xét nghiệm Coombs trực tiếp và gián tiếp dương tính 3+, thành phần gắn trên bề mặt hồng cầu có bản chất là C3d. Dịch tách từ hồng cầu bệnh nhân có phản ứng dương tính với hồng cầu nhóm máu O đã hấp phụ cefoxitin và không phản ứng với hồng cầu nhóm máu O bình thường. Bệnh nhân ngừng sử dụng cefoxitin và được truyền 2 khối hồng cầu có xét nghiệm hòa hợp dương tính 3+ ở điều kiện có kháng globulin người, quá trình truyền máu diễn ra bình thường. Sau truyền máu, bệnh nhân ổn định, Hb đạt 90g/L. Kết luận: Bệnh nhân tan máu do cefoxitin
bệnh nhân dừng thuốc và truyền khối hồng cầu có hiệu quả.

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