丙硫氧嘧啶致粒细胞缺乏患者的药学监护

1例78a女性患者,20年前因甲状腺功能亢进给予甲巯咪唑片及左甲状腺素片治疗。2006年复查甲状腺功能正常,逐渐减少甲巯咪唑片用量至停用。2008年11月,该患者的甲状腺功能亢进复发,并出现急性房颤,再次口服甲巯咪唑片治疗,并加用β-受体阻滞剂控制心率。因效果不明显,换用丙硫氧嘧啶片。治疗过程中患者出现白细胞减少,遂给予升高白细胞的药物。2008年12月30日,实验室检查示：WBC1.51×109·L-1,NEUT0.07×109·L-1。2009年1月1日,患者因＂粒细胞缺乏伴发热＂再次入院后给予抗感染和升白细胞治疗等。结合患者的感染程度及血常规检查结果,临床药师建议给予美罗培南,并对重组人粒细胞集落刺激因子的剂量给予建议。4周后患者的血常规结果恢复正常,病情稳定出院。

Pharmaceutical care for agranulocytosis induced by propylthiouracil

A 78-year-old female patient with hyperthyroidism was given methimazole and levothyroxine twenty years ago.The drugs were stopped for the normal thyroid function since 2006.In November 2008,she suffered from hyperthyroidism relapse and acute atrial fibrillation.She received methimazole again and β-receptor blocker for controlling of heart rate.For little effect of methimazole,propylthiouracil was applied.Leukocyte stimulants were used to treat leucopenia appearing in the treatment.Laboratory test revealed following levels：WBC count 1.51×109·L-1,neutrophile granulocyte count 0.07×109·L-1 on 30 December 2008.She was admitted to hospital with diagnosis as agranulocytosis with fever,and Graves disease on 1 January 2009.Leukocyte stimulants and anti-infective treatment were conducted.During these treatments,clinical pharmacists suggested using meropenem,a broad-spectrum antibiotics,for severe infection due to agranulocytosis and adjusting the dosage of human recombinant granulocyte colony-stimulating factor.After 4 weeks of therapy,the patient＇s blood routine returned to normal.Her status became stable and was discharged.