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[日本新冠疫情期间血液系统疾病患者的实际管理]

[Practical management of the patients with hematological diseases during the COVID-19 pandemic in Japan].

作者信息

Hagihara Masao, Ohara Shin, Uchida Tomoyuki, Inoue Morihiro

机构信息

Eiju General Hospital.

出版信息

Rinsho Ketsueki. 2021;62(2):115-124. doi: 10.11406/rinketsu.62.115.

Abstract

PCR assay cannot always detect the SARS-CoV2 virus, which might be due to differences in the sensitivities of each sampling site. Under these circumstances, immunochromatography may serve as an alternative method to detect anti-SARS-CoV-2 IgG antibodies that can demonstrate a history of infection. In patients with severe COVID-19 infection, 14 of 19 serum samples were shown to be positive, whereas 6 of 10 samples from patients with asymptomatic or mild cases were negative for IgG antibodies. Two patients with immune thrombocytopenia, who were treated with prednisolone, experienced aggressive behavior of COVID-19-related respiratory failure and eventually died. Patients who were before an achievement of remission and those who received steroid-based chemotherapy possessed a higher risk of death, and more deaths were observed in patients with lymphoid malignancies including lymphoma and myeloma compared with those with myeloid malignancies. As for daily medical care in hematological department, a stricter cohorting strategy using repeat PCR tests or isolation to a private room should be adopted in order to prevent viral spread to the environment.

摘要

聚合酶链反应(PCR)检测并不总能检测到严重急性呼吸综合征冠状病毒2(SARS-CoV-2),这可能是由于每个采样部位的灵敏度存在差异。在这种情况下,免疫层析法可作为一种替代方法,用于检测抗SARS-CoV-2 IgG抗体,该抗体可证明有感染史。在重症冠状病毒病2019(COVID-19)感染患者中,19份血清样本中有14份呈阳性,而10份无症状或轻症患者的样本中有6份IgG抗体呈阴性。两名接受泼尼松龙治疗的免疫性血小板减少症患者出现了与COVID-19相关的呼吸衰竭的侵袭性行为,最终死亡。在病情缓解之前的患者以及接受基于类固醇的化疗的患者死亡风险更高,与髓系恶性肿瘤患者相比,在包括淋巴瘤和骨髓瘤在内的淋巴系恶性肿瘤患者中观察到更多死亡病例。至于血液科的日常医疗护理,应采用更严格的分组策略,使用重复PCR检测或隔离到单人病房,以防止病毒传播到环境中。

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