口服甲氨蝶呤致尿毒症患者急性造血功能停滞

1例60岁女性尿毒症维持性血液透析患者,因关节疼痛口服甲氨蝶呤7.5mg。2d后全身出现散在红疹、咽痛、口腔溃疡、双上臂散在瘀斑。4d后血常规检查：WBC0.6×109/L,RBC2.13×1012/L,Hb69g/L,PLT24×109/L,Ret0.1%。骨髓穿刺细胞学检查：粒细胞系、红细胞系及巨核细胞系均增生低下。给予甲泼尼龙80mg静脉滴注、非格司亭300μg皮下注射、人免疫球蛋白2.5mg静脉滴注、血小板10万U输注及对症支持治疗。随后症状逐渐改善,血常规恢复既往水平。

Acute arrest of hematopoiesis due to oral methotrexate in a patient with uremia

A 60-year-old woman undergoing maintenance hemodialysis due to uremia received oral methotrexate 7.5 mg for arthralgia.Two days later,she developed generalised sporadic red rashes,sore throat,mouth ulcer,and sporadic ecchymosis in upper arms.Four days later,routine blood testing revealed the following levels：WBC count 0.6×109/L,RBC count 2.13×1012/L,Hb 69 g/L,PLT count 24×109/L,and reticulocyte count 0.1%.Bone marrow aspiration showed hypoplasia of granulocyte,red blood cell,and megakaryocytic series.She was treated with an IV infusion of methylprednisolone 80 mg,SC filgrastim 300 μg,an IV infusion of human immunoglobulin 2.5 mg,platelet 100,000 U transfusion,and symptomatic and supportive therapies.Subsequently,her symptoms improved gradually and her routine blood testing results returned to previous levels.