Roth B, Grände P O, Nilsson-Ehle P, Eliasson I
Department of Anaesthesia, University Hospital, Sweden.
Intensive Care Med. 1993;19(2):111-4. doi: 10.1007/BF01708372.
We describe a case of life-threatening haemophagocytosis after a short term nutrition with fat emulsion in a 21-year-old woman who sustained an isolated traumatic brain injury. Hypertriglyceridemia and "creaming plasma" were observed after a three-day period of parenteral fat nutrition (Intralipid 20%). She also developed rash, high fever (40-41 degrees C), hypertension, raised intracranial pressure, hepatic and renal failure, haemolysis, marked thrombocyto- and leucopenia, coagulation disorder and pulmonary failure. These symptoms, together with a typical bone marrow smear, indicated haemophagocytosis with hyperactivation of the monocyte-macrophage system. We suggest that the hyperactivation was an effect of fat retention or agglutination of the fat particles; the initial triggering mechanism may emanate from the brain damage by hypercytokinaemia. The steroid treatment given most likely contributed to the successful outcome, as indicated by the stepwise improvement related in time to the steroid infusions.
我们描述了一例21岁孤立性创伤性脑损伤女性在短期接受脂肪乳剂营养后出现危及生命的噬血细胞综合征的病例。在接受三天肠外脂肪营养（20%英脱利匹特）后，观察到高甘油三酯血症和“血浆乳糜化”。她还出现了皮疹、高热（40 - 41摄氏度）、高血压、颅内压升高、肝肾功能衰竭、溶血、明显的血小板减少和白细胞减少、凝血障碍以及呼吸衰竭。这些症状，连同典型的骨髓涂片，提示单核细胞 - 巨噬细胞系统过度激活的噬血细胞综合征。我们认为这种过度激活是脂肪潴留或脂肪颗粒凝集的结果；初始触发机制可能源于脑损伤引起的高细胞因子血症。如与类固醇输注时间相关的逐步改善所示，给予的类固醇治疗很可能促成了成功的结果。
