低分子肝素钙和万古霉素致一患者骨科术后严重血小板减少

一58岁男性因骨折，手术前后使用低分子肝素钙数日，术后第7天使用万古霉素，第17天出现发热，第20天因药物热停万古霉素，复查发现血小板减少，最低8.0×109/L，诊断为急性血小板减少性紫癜，即停用低分子肝素钙，并使用激素升血小板。3日后血小板升至59×109/L，停用激素，5天后血小板恢复至正常水平153×109/L，全身皮肤及鼻、黏膜等无出血点及瘀斑。

Serious Thrombocytopeni Induced by Low Molecular Weight Heparin Calcium and Vancomycin in an Orthopaedic Surgery

A 58-years-old male patient with fracture, used low molecular weight heparin calcium for several days before and after the surgery. After operation, he used vancomycin on day 7, appeared drug fever on day 17, and stopped vancomycin on day 20. CBC recheck revealed thrombocytopenia, the lowest level of blood platelet was 8.0 ×109/L, which was diagnosed as acute thrombocytopenic purpura. Then low molecular weight heparin calcium was stopped using immediately and hormone was used to raise the blood platelet. The blood platelet rose to 59×109/L on the third day and the hormone treatment was stopped, the patient's blood platelet returned to normal level at 153 ×109/L on the fifth day, body skin and mucous membranes were out of bleeding and ecchymosis.