摘要
目的总结血抗人球蛋白试验阴性的自身免疫性溶血性贫血(AIHA)患者的临床特点、诊治方法及误诊原因、防范措施。方法回顾性分析2019年6月—2023年9月收治的曾误诊的血抗人球蛋白试验阴性的AIHA 11例的临床资料。结果6例因黑便就诊,误诊为急性上消化道出血;2例因腹痛、黄疸就诊,腹部CT提示胆总管结石,误诊为胆总管结石伴急性胆管炎;3例因晕厥就诊,查叶酸、维生素B 12降低,血常规示大细胞性贫血,误诊为巨幼细胞性贫血。误诊时间(4.82±1.67)d。11例血抗人球蛋白试验均阴性,6例经诊断性治疗和综合评估病情,2例通过骨髓单个核细胞抗人球蛋白试验阳性,3例转诊至外院通过微柱凝胶法查自身抗体阳性确诊血抗人球蛋白试验阴性AIHA。11例给予相应治疗后9例预后良好,1例死亡;1例疗效不佳放弃进一步治疗出院。结论血抗人球蛋白试验阴性AIHA临床少见,缺乏特异性症状、体征,易误诊。加强临床医生对该病认识,提高警惕性;对高度怀疑AIHA但血抗人球蛋白试验阴性患者经综合病情评估后可予诊断性治疗,必要时筛查骨髓抗人球蛋白试验或转诊至上级医院。
Objective To summarize the clinical characteristics,diagnosis and treatment,causes of misdiagnosis and preventive measures of autoimmune hemolytic anemia(AIHA)with negative results for Coombs test.Methods The clinical data of 11 patients with misdiagnosed AIHA with negative results for Coombs test admitted from June 2019 to September 2023 were retrospectively analyzed.Results Six patients presented with black stool and were misdiagnosed as acute upper gastrointestinal bleeding.Two patients presented with abdominal pain and jaundice,abdominal CT showed choledocholithiasis,and they were misdiagnosed as choledocholithiasis with acute cholangitis.Three patients presented with syncope;folate and vitamin B 12 were decreased,and the blood routine showed macrocytic anemia;therefore,they were misdiagnosed with megaloblastic anemia.The duration of misdiagnosis was(4.82±1.67)d.All 11 patients were tested negative for Coombs test,6 patients were diagnosed after diagnostic therapy and comprehensive evaluation,2 patients were confirmed by positive results for Coombs test of bone marrow mononuclear cell,and 3 patients were referred to other hospitals and diagnosed as Coombs test negative AIHA for positive results of autoantibodies by microcolumn gel method.All 11 patients received corresponding treatment,of whom 9 patients had a favorable prognosis,1 patient died,and 1 patient gave up treatment and was discharged.Conclusion Coombs test negative AIHA is rare in clinical practice and lack of specific symptoms and signs,which is,therefore,more likely to be misdiagnosed.To strengthen clinicians'awareness of this disease and enhance their vigilance.For those who are highly suspected of AIHA but have a negative results for Coombs test,diagnostic treatment can be given after comprehensive evaluation.If necessary,Coombs test of bone marrow cells for screening or referral to a higher-level hospital can be provided.
作者
薛祥
黄昌保
孟健康
聂时南
XUE Xiang;HUANG Changbao;MENG Jiankang;NIE Shinan(Department of Emergency,Jinling Hospital Affiliated to Nanjing University School of Medicine Chinese People's Liberation Army Eastern Theater Command General Hospital,Nanjing 210002,China;Department of Emergency,the First Affiliated Hospital of Wannan Medical College Yijishan Hospital,Wuhu,Anhui 241000,China)
出处
《临床误诊误治》
CAS
2024年第8期5-9,共5页
Clinical Misdiagnosis & Mistherapy
基金
江苏省自然科学基金(BK20211136)
中国博士后科学基金(2020M670089ZX)。
关键词
贫血
溶血性
自身免疫性
抗人球蛋白试验阴性
误诊
上消化道出血
胆总管结石
胆管炎
贫血
巨幼细胞性
Anemia,hemolytic,autoimmune
Negative results for Coombs test
Misdiagnosis
Upper gastrointestinal bleeding
Choledocholithiasis
Cholangitis
Anemia,megaloblastic
