學齡前期兒童血尿及發燒症狀之溶血性貧血案例分析

Hemolytic Anemia with Hematuria and Fever in A Preschooler: A Case Report

發燒合併血尿的病徵在臨床上常被臆測與泌尿 系統疾病有關。文中個案乃為一名學齡前期之 女童，入院前數週開始有間歇性高燒、食慾不 振、咳嗽等症狀，幾經治療，狀況未獲改善， 甚至出現血尿等病徵，初期被揣測罹患溶血性尿 毒症候群（hemolytic uremic syndrome, HUS）而收 入院。入院後透過身體評估、縝密的病史收集， 並在主治醫師引導下，剖析致病原、研擬相關 檢驗，確診為自體免疫溶血性貧血（autoimmune hemolytic anemia, AIHA），在給予相關治療後， 病況得以改善。目前AIHA的確診主要仰賴摒除 其他溶血性貧血疾病的可能性，對臨床經驗有限 的醫療人員而言，在執行鑑別診斷及策劃適切的 治療上，頗具艱難度。建議若病患本身無貧血之 病歷記載卻急速出現貧血的表徵，家族中亦無血 液方面之相關遺傳病史，即應高度考慮自體免疫 溶血性貧血的可能。即時給予妥善的醫療處置， 方能降低合併症及致死的發生率

 

The coexistence of a fever and hematuria is generally considered as urological diseases. We present an exception case. This 4-year-old girl had an intermittent fever weeks prior to admission. Cough, anorexia and malaise were also noted. She called our hospital because of the development of hematuria. She was admitted to our pediatric ward under the impression of hemolytic uremic syndrome (HUS). A diagnosis of AIHA was made after history taking, physical and laboratory examinations. The patient improved gradually after given treatment for AIHA. It is difficult for the unexperienced medical staff to make the diagnosis and provide therapeutic plans for AIHA clinically. AIHA should be suspected in acute anemic patients without anemia-related history and timely treatment may reduce patient mortality and morbidity.