Reid M M
Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Acta Paediatr. 1992 Dec;81(12):1052-3. doi: 10.1111/j.1651-2227.1992.tb12175.x.
Corticosteroids were used to treat two children with presumed idiopathic thrombocytopenic purpura and one with juvenile rheumatoid arthritis without examination of the bone marrow. Of the two with presumed idiopathic thrombocytopenic purpura, one had Fanconi's anaemia and the other may have had aplastic anaemia. The third child had acute lymphoblastic leukaemia. The diagnosis of Fanconi's anaemia was delayed. A diagnostic and therapeutic dilemma was caused in the second case. In the third, delayed diagnosis and, perhaps, compromised outlook resulted. These three cases re-emphasize the well aired caveats about the diagnosis of idiopathic thrombocytopenic purpura and juvenile rheumatoid arthritis and provide further support for the arguments of those who believe that if corticosteroids are to be used to treat such children, their bone marrow should be examined first.
在未进行骨髓检查的情况下，使用皮质类固醇治疗了两名疑似特发性血小板减少性紫癜的儿童和一名青少年类风湿性关节炎患儿。在两名疑似特发性血小板减少性紫癜的患儿中，一名患有范可尼贫血，另一名可能患有再生障碍性贫血。第三名患儿患有急性淋巴细胞白血病。范可尼贫血的诊断被延误。第二例造成了诊断和治疗上的两难局面。第三例则导致了诊断延误，可能还影响了预后。这三例病例再次强调了关于特发性血小板减少性紫癜和青少年类风湿性关节炎诊断的那些老生常谈的注意事项，并为那些认为如果要用皮质类固醇治疗此类患儿就应先检查其骨髓的人的观点提供了进一步支持。
