溶血指标联合监测在淋巴瘤相关噬血细胞综合征继发Evans综合征疗效评估中的价值OA

Objective To investigate the value of combined monitoring of hemolytic reaction indicators in the efficacy assessment of lymphomaassociated hemophagocytic lymphohistiocytosis(LAHLH)secondary to Evans syndrome(ES).Methods One patient with LAHLH secondary to ES complicated by hemolytic crisis was enrolled.Under the premise that necessary red blood cell transfusions were administered due to severe anemia,combined dynamic monitoring was performed for the following hemolytic reaction indicators:posttransfusion hemoglobin increment,reticulocyte percentage(RET%),to-tal bilirubin(TBil),lactate dehydrogenase(LDH),and direct antiglobulin test(DAT).Furthermore,based on the litera-ture of the past five years,we analyzed the relationship between the dynamic changes of the these indicators and the response to immunosuppressive therapy.Results During the hemolytic crisis period,the 24hour posttransfusion hemoglobin incre-ments were both<10 g/L after two consecutive red blood cell transfusions,indicating ineffective transfusion.After intensi-fied immunosuppressive therapy,the hemoglobin increments reached+14 g/L and+15 g/L,respectively,after two subse-quent transfusions,converting to effective transfusion.Concurrently,RET%decreased from a peak of 29.32%to 12.71%,and LDH and bilirubin improved synchronously.The combined interpretation of hemoglobin increment,dynamic RET%trends,and DAT results facilitated the distinction of the relative contributions of immune hemolysis,hemophagocytosis,and bone marrow failure to anemia.Conclusion Under the strict premise that transfusion indications are adhered to and patient safety is ensured,,combined dynamic monitoring of hemolytic reaction indicators can provide realtime,objective bedside auxiliary information for the efficacy assessment of LAHLH secondary to ES,and has certain clinical value in optimizing the timing of treatment adjustments.