O型患者非同型肝移植引发免疫性过客淋巴细胞综合征1例

过客淋巴细胞综合征[1](passenger lymphocyte syndrome,PLS)是患者行移植术后,供体残留的B淋巴细胞针对受体抗原产生的免疫性抗体而引起的一系列症状,包括供体残留的B淋巴细胞或浆细胞进入受体被激活后增殖,产生针对受者红细胞抗原的抗体,症状以溶血为主.ROMERO[2]等提出肝移植中ABO血...     

ABO血型次侧不相合肾移植术后过客淋巴细胞综合征1例

目的对1例ABO血型次侧不相合二次异体肾移植术后,引起过客淋巴细胞综合征病例进行分析,探讨其血清学特点及临床输血策略。方法血型鉴定、抗体筛选、抗体鉴定、直接抗人球蛋白试验、效价测定、交叉配血选用卡式抗人球蛋白法进行试验,同时选用试管法进行血型鉴定、抗体筛选、抗体鉴定、放散试验、交叉配血。结果供者血型为O型,患者血型为B型,直接抗球蛋白试验阳性,热放散表明患者产生IgG抗-B,与O型辐照洗涤红细胞交叉配血相合,输注效果良好。结论 ABO非同型肾移植术后,应警惕发生过客淋巴细胞综合征,需输血治疗时应选择与供者血型相符的红细胞。     

1例葡萄糖-6-磷酸脱氢酶缺乏症患者行ABO血型不合肝移植术并发过客淋巴细胞综合征的护理

1例葡萄糖-6-磷酸脱氢酶缺乏症患者行ABO血型不合肝移植术后过客淋巴细胞综合征的救治与护理经验。该患者病情复杂,确诊过客淋巴细胞综合征的干扰因素多,纠正贫血使用的血制品及治疗药物的选择难,对护士病情的观察、肝移植术后发生贫血相关因素的判断能力要求较高。护士通过病情观察、检验指标及相关实验室检查协助医生确诊过客淋巴细胞综合征;安全有效地输注洗涤红细胞纠正过客淋巴细胞引起的自身免疫性溶血性贫血;做好糖皮质激素联合丙种球蛋白治疗药物的护理。经过精心治疗及护理,本例患者过客淋巴细胞综合征得到治愈,未出现输血及药物相关并发症,移植肝功能一直稳定,顺利康复出院,随访情况良好。     

1例肾移植术后过客淋巴细胞综合征患者的护理

目前,肾移植是终末期肾功能衰竭患者的最佳治疗方式,可以有效提高患者的生存质量[1].肾移植手术的供肾来源主要是公民逝世后器官捐献,随着医学的进步,为了解决供肾短缺问题,非同型血型肾移植手术逐步在临床开展,肾移植患者的术后生存率也在不断提高.但非同型血型的肾移植术有发生过客淋巴细胞综合征(passenger lympho...     

ABO非同型肝移植患者术后过客淋巴细胞综合征引起配血不合1例

目的探讨ABO非同型肝移植患者术后交叉配血不合的影响因素及早期监测和干预移植术后过客淋巴细胞综合征的意义。方法对1例ABO非同型肝移植术后12d与多名A型献血员交叉配血不合的患者,进一步进行供受者血型复检、抗体筛查、直接抗人球蛋白试验、放散试验及抗体鉴定等检测,并统计患者术后血红蛋白及胆红素指标,分析该患者交叉配血不合的原因及影响因素。结果该患者血型为A型RhD阳性,肝脏供者为O型RhD阳性;抗体筛查阴性;直接抗人球蛋白试验阳性,放散后抗体鉴定提示术后过客淋巴细胞产生为IgG抗-AB和抗-A抗体。该患者因术后过客淋巴细胞产生ABO血型抗体导致配血不合。患者血红蛋白进行性下降,但未见总胆红素等溶血反应相关指标明显升高,也没有相关临床症状,仅表现为与多名A型献血者交叉配血不合和直接抗人球蛋白试验阳性。结论由于供体紧缺,血型不合的器官移植或造血干细胞移植在临床中不可避免,目前暂无有效的方法预测PLS。定期监测移植术后患者血红蛋白水平、胆红素水平、直接抗人球蛋白试验和抗体筛查试验结果,尽早发现PLS引起的溶血反应并及时干预可有效避免患者预后不良,提高移植成功率。     

HLA全相合ABO血型不合骨髓血输注发生急性溶血反应1例的护理

2009-04我科1例慢性粒细胞白血病患者行异基因造血干细胞移植术期间,输注骨髓血时发生急性溶血反应,现将护理体会报道如下。1病历摘要女,33岁。2009-02确诊为慢性粒细胞白血病,予环磷酰胺加羟基脲治疗。患者与其胞姐HLA配型全相合,受体血型O型,     

异基因造血干细胞移植后发生过客淋巴细胞综合征患儿的临床分析并文献复习

目的探讨异基因造血干细胞移植(allo-HSCT)后发生过客淋巴细胞综合征(PLS)患儿的临床特点、诊断和治疗方法, 并且进行相关文献复习。方法选择2019年6月30日, 四川大学华西第二医院收治的1例ABO血型次侧不相合allo-HSCT后发生PLS男孩为研究对象。对患儿的临床病例资料进行回顾性分析, 总结其临床特点。本研究设定的检索策略为:以"过客淋巴细胞综合征""passenger lymphocyte syndrome""PLS"为中、英文关键词, 分别对中国知网数据库、万方知识服务平台和PubMed数据库建库至2020年4月30日收录的未成年人(<18岁)接受allo-HSCT后PLS的相关文献进行检索, 并对PLS患儿的诊治经验进行总结。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①病史采集:本例男孩年龄为2岁6个月, 因"先天性角化不良"于2019年7月9日接受allo-HSCT。allo-HSCT后第5天, 患儿血红蛋白(Hb)值开始呈进行性下降, 总胆红素(TB)、乳酸脱氢酶(LDH)水平进行性升高;allo-HSCT后第9天Hb值...     

母婴血型不合致新生儿溶血病231例分析

目的探讨母婴血型差异及相关IgG抗体水平与新生儿溶血病的关系。方法对临床送检的新生儿高胆红素血症的母婴血标本进行ABO和Rh血型鉴定,对新生儿血标本进行直接抗人球蛋白试验、游离抗体试验和放散试验,对确诊HDN的患儿测定相关IgG抗红细胞抗体及效价,并分析抗体效价与患儿血清总胆红素的关系。结果 256份送检标本经溶血3项试验确诊为HDN231例,其中母婴ABO血型不合229例,Rh血型不合2例。ABO血型不合中,母亲为O型,新生儿为A型或B型共208例;母亲为A型或B型,新生儿为B型或A型共21例,抗体效价64～512。2例Rh血型不合者经抗体鉴定为1例抗-E,效价128;另1例抗-E合并抗-c,效价分别为256和64;不同抗体效价组间患儿总胆红素水平差异有统计学意义（χ2=2.32,P〈0.05）。结论新生儿溶血病主要以母婴ABO血型不合为主,抗体效价越高,溶血越严重。     

An unusual cause of ischemic claudication: a case report

A 56-year-old woman with a chief complaint of left lower-extremity numbness was referred by her gynecologist to the physical medicine clinic for workup of presumed lumbosacral radiculopathy. She had no history of low back pain, and her symptoms were elicited only with exercise. Results of her neurologic examination and lumbosacral radiographs were normal. Her medical history was significant for advanced cervical cancer, successfully treated with local surgery followed by high-dose pelvic radiation and chemotherapy 2 years before the current onset of symptoms. Subsequent workup with Doppler and arteriogram studies discovered a 3-cm area of diffuse stenosis of the left external iliac artery for which she was successfully treated with balloon angioplasty. This case presents an unusual cause of left leg claudication secondary to left iliac artery stenosis 2 years after pelvic radiation for cervical cancer and shows the necessity for a detailed evaluation of patients' medical histories.     

An unusual cause of mismanagement in an acute myocardial infarction case: pseudothrombocytopenia

Thrombocytopenia determined by an automated counter may represent a benign, incidental finding in an asymptomatic patient or a potentially life-threatening disorder. Even if the low platelet count actually is a benign condition itself, in some conditions, any delay resulting from this condition consequently may be seriously hazardous. Low platelet count may alter the decision of heparin administration, which is an essential part of management during acute coronary syndromes. EDTA-dependent pseudothrombocytopenia (PTCP) is reported to have a prevalence of 0.1% in a general hospital; however, it is also reported that around 15% of the patients referred for a specialized center for isolated thrombocytopenia are actually cases of PTCP. In this report, we describe a patient with PTCP who could not receive reperfusion therapy during acute myocardial infarction because of the low platelet counts reported by an automated counter.     

Down syndrome with an unusual etiology: case report and review

PURPOSE: To present the genetic etiology of an unusual case of Down syndrome, arising from translocation of chromosome 21 to chromosome 9; to discuss advanced genetic diagnostic techniques, focusing on how pinpointing a specific genetic mistake can influence treatment and outcome; and to review the role of the nurse practitioner (NP) in caring for families of children with Down syndrome. DATA SOURCES: Case report, literature review, and advanced genetic techniques. CONCLUSIONS: NPs often answer patient questions regarding genetic abnormalities and risk factors for transmission of genetic errors to offspring. Advanced genetic analysis allows for the diagnosis of unusual causes of common genetic disorders. The ability to identify a specific genetic mistake and to predict the scope of its effect on an individual offers health care providers the opportunity to develop a case-by-case plan of care. IMPLICATIONS FOR PRACTICE: NPs have a responsibility to be informed about the processes involved in the transmission of genetic errors and about the subtleties of various expressions of a genetic disorder. The availability of new genetic-testing techniques allows NPs to individualize patient care and family teaching.     

An unusual cause of postpartum abdominal pain: case report

Abdominal pain is a common presenting complaint in the Emergency Department. It extends to all populations regardless of age, sex, or socioeconomic status. After gathering a history and examining the patient, most Emergency Physicians form a differential diagnosis and initiate an appropriate work-up. However, in the postpartum woman, additional causes must be considered and treated accordingly, knowing that there are consequences for both mother and child. We present a case of a postpartum woman presenting with right-sided abdominal pain, the cause of which, although atypical, has potential for significant morbidity and mortality if it goes undiscovered.     

Bone wax as a cause of foreign body reaction after lumbar disc surgery: A case report

This report describes a 45-year-old patient who was admitted to the hospital with complaints of low-back pain, lower extremity weakness, and difficulty in walking for the previous 6 mo. The patient’s history revealed 2 lumbar-disc surgeries that were performed 1 y earlier. The patient underwent surgery at our hospital because of clinical symptoms and radiologic findings on magnetic resonance imaging. During the operation, 1×1×1 cm of bone wax that was compressing the dural sac and spinal root was extirpated from the surgical area. Bone wax use should be limited in spinal surgery because of the potential for compression and chronic inflammation.     

Cysticercosis of temporalis muscle: an unusual cause of temporal headaches. A case report

Cysticercosis is a common parasitic infection caused by encysted larvae of the helminth Taenia solium (pork tapeworm). The central nervous system (CNS) is the most important primary site of infection and the disease can present with solitary or multiple space occupying lesions. Less common presentations in the CNS include the racemose variety with macroscopic groups of cysticerci in the subarachnoid space giving the appearance of a cluster of grapes and basal or ventricular cysticercosis causing obstructive hydrocephalus. Involvement of other organs: skeletal muscle, eyes, myocardium and the lungs has also been reported. Cases of cysticercosis presenting as isolated muscle mass (pseudotumours) without involvement of the CNS have also been recently described in the literature. We present a case of a 43-year-old woman who complained of subacute onset of left temporal pain and headache. Magnetic resonance imaging (MRI) showed characteristic imaging findings suggestive of cysticercosis of the temporalis muscle.     

An unusual cause of hemolysis in a patient with an aortic valved conduit replacement.

Hemolytic anemia is a well-known but uncommon complication in patients with prosthetic heart valves. It is most commonly a result of prosthetic valve dysfunction, periprosthetic valvular regurgitation, or both. We report a case of a 41-year-old man who had a previous aortic valve and root replacement for acute proximal aortic dissection, now presenting with hemolytic anemia. This was a result of flow obstruction at the distal anastomosis of the aortic conduit by the presence of multiple dissection flaps resulting in severe flow turbulence. Although the pathology was at the blind spot for transesophageal echocardiography, the dissection flaps, the flow turbulence, and the degree of obstruction were well-demonstrated by this technique after careful manipulation of the probe and a high index of suspicion.