论文部分内容阅读
1名33岁男性慢性粒细胞白血病患者,在接受同种异基因造血干细胞移植前依次给予白消安、环磷酰胺、抗胸腺细胞球蛋白进行预处理。在移植前3d,患者开始接受抗胸腺细胞球蛋白(ATG)200mg加入0.9%氯化钠注射液500ml静脉滴注,滴速为25～50ml/h。滴注3.5h后,患者出现寒颤,体温逐渐升至39.6℃。给予对症处理。应用ATG8h后,患者出现浓茶色尿,尿常规显示:蛋白(++++),pH8.5,RBC(-),潜血(++)。停用ATG,给予大剂量碳酸氢钠注射液。次日晨,患者尿色变浅,尿常规基本恢复正常。遂给予第2剂ATG200mg静脉滴注,滴速10ml/h,0.5h后患者出现酱油色尿,再次停药并给予碳酸氢钠注射液,2d后患者尿色及尿检结果恢复正常。后采用巴利昔单抗替代ATG进行预处理,患者未再发生异常反应。
A 33-year-old man with CML received pretreatment with busulfan, cyclophosphamide and anti-thymocyte globulin before receiving allogeneic hematopoietic stem cell transplantation. At 3 days prior to transplantation, patients started receiving 200 mg anti-thymocyte globulin (ATG) plus 500 ml 0.9% sodium chloride injection intravenously at a drop-off rate of 25-50 ml / h. 3.5h after instillation, patients shivering, body temperature gradually rose to 39.6 ℃. Give symptomatic treatment. After application of ATG8h, patients developed thick brown urine, urine showed: protein (++++), pH8.5, RBC (-), occult blood (++). ATG was discontinued and high-dose sodium bicarbonate injection was given. The next morning, patients pale urine, urine routine returned to normal. Then give the second dose of ATG200mg intravenous drip, drip rate 10ml / h, 0.5h after the patient appeared soy sauce color urine, stop taking sodium bicarbonate injection and again, 2d urine and urine test results returned to normal. After the use of basiliximab instead of ATG pretreatment, the patient no further abnormal reaction.