尼美舒利致儿童溶血性贫血

1例21个月男性患儿因上呼吸道感染给予尼美舒利颗粒50 mg分2次服用（间隔15 h）。第1次服药后3 h,患儿出现抽搐、面色苍白、小便变黄。第2次服药后15 min再次出现抽搐,面色苍白进行性加重,小便呈浓茶色。入院后实验室检查：C反应蛋白79.0 mg/L;白细胞计数35.6×109/L,中性粒细胞计数27.1×109/L,血红蛋白33 g/L,血小板计数471×109/L;凝血酶时间17.2 s,凝血酶原时间20.4 s,国际标准化比值1.63,活化部分凝血活酶时间27.5 s,纤维蛋白原2.95 g/L。予心电监护、吸氧,静脉滴注地塞米松、甲泼尼龙及人免疫球蛋白,静滴碳酸氢钠,输注洗涤红细胞。患儿病情加重,出现昏迷、四肢抽动,血压131/103 mm Hg（1 mm Hg=0.133 kPa）,心率153次/min。予血浆置换、抗感染、免疫抑制、水化及营养支持治疗,患儿病情好转。入院第8天复查血常规：白细胞计数7.0×109/L,中性粒细胞计数5.3×109/L,血红蛋白117 g/L,血小板311×109/L,网织红细胞0.02。

Nimesulide-induced hemolytic anemia in a child

A 21-month-old boy with upper respiratory tract infection was given nimesulide granules 50 mg in 2 divided doses at 15-hour intervals. Three hours after taking the first dose, he developed convulsion, pallor and yellowish urine. Fifteen minutes after taking the second dose, he redeveloped convulsion, progressive worsening pallor, strong tea-colored urine. Laboratory tests showed the following levels and values： C-reactive protein 79.0 rag/L, white blood cell count 35.6 × 109/L, neutrophil count 27. 1 × 109/L, hemoglobin 33.0 g/L, platelet count 471 × 109/L, thrombin time 17. 2 seconds, prothrombin time 20.4 seconds, international normalized ratio 1.63 and activated partial thromboplastin time 27.5 seconds, fibrinogen 2.95 g/L. He underwent electrocardiogram monitoring and received oxygen inhalation therapy, an IV infusion of dexamethasone, methylprednisolone and human immunoglobulin, an IV infusion of sodium bicarbonate, and a transfusion of washed red blood cells. The child worsened and presented with coma, twitching limbs, his blood pressure was 131/103 mm Hg and his heart rate was 153 beats/rain. He was treated with plasma exchange, anti-infective therapy, immunosuppressive drugs, hydration, and nutritional support, and then his condition improved. On hospital day 8, repeat routine blood tests showed a white blood cell count of 7.0 × 109/L, a neutrophil count of 5.3 × 109/L, a hemoglobin level of 117 g/L, a platelet count of 311 × 109/L, and a reticulocyte count of O. 02.