一例过敏性输血反应疑似诱发Kounis综合征引起心率骤降的病例及文献分析

doi:10.3969/j.issn.1671-2587.2025.01.012

临床输血与检验 ›› 2025, Vol. 27 ›› Issue (1): 83-88.DOI: 10.3969/j.issn.1671-2587.2025.01.012

一例过敏性输血反应疑似诱发Kounis综合征引起心率骤降的病例及文献分析

邵明¹, 孔永奎¹, 李慧娟¹, 田爱华¹, 田文亮², 周帅³, 张青青⁴, 杨乾坤¹

¹郑州大学第一附属医院输血科,河南郑州 450052;
²郑州大学第一附属医院血液内科,河南郑州 450052;
³郑州大学第一附属医院心内科,河南郑州 450052;
⁴西华县人民医院心电图室,河南周口 466600

收稿日期:2024-11-16 发布日期:2025-02-25
通讯作者: 杨乾坤,主要从事输血方面研究,（E-mail）yqiankun@126.com。
作者简介:邵明,主要从事输血、血液病方面研究,（E-mail）SXKshaoming@126.com。

A Case Report and Literature Analysis of Allergic Blood Transfusion Reaction Suspected to Induce Kounis Syndrome and Cause Sudden Heart Rate Drop

SHAO Ming¹, KONG Yongkui¹, LI Huijuan¹, TIAN Aihua¹, TIAN Wenliang², ZHOU Shuai³, ZHANG Qingqing⁴, YANG Qiankun¹

¹Department of Blood Transfusion, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052;
²Department of Hematology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou 450052;
³Department of cardiology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou 450052;
⁴Department of Electrocardiography, Xihua County People's Hospital, Zhoukou 466600

Received:2024-11-16 Published:2025-02-25

摘要/Abstract

摘要： 目的探讨过敏性输血反应后发生Kounis综合征的可能性和诊治方法。方法对一例输血后发生严重输血反应的患者进行回顾性分析。结果患者输注含有血浆的血制品多次出现过敏等输血反应,表现为全身瘙痒、精神异常、意识模糊、偶有胸闷,给予抗过敏、糖皮质激素后好转;最严重一次表现为心率骤降,给予血管活性药物、糖皮质激素十余分钟后恢复,考虑为Kounis综合征。结论严重的过敏性输血反应合并心血管症状时,需鉴定是否为Kounis综合征并进行全面的心脏系统检查,确保患者得到及时的诊治。

关键词: 过敏, 输血反应, Kounis综合征, 心率骤降

Abstract: Objective To explore the possibility of Kounis syndrome and its diagnosis and treatment strategies following allergic transfusion reaction. Methods A retrospective analysis was done of a patient who developed a severe allergic reaction after receiving blood transfusion. Results The patient experienced multiple allergic reactions and other transfusion-related events after receiving blood products containing plasma, manifested as systemic itching, altered mental status, blurred consciousness, and occasional chest tightness. After treatment with antihistamines and glucocorticoids, the condition improved. The most severe manifestation was sudden drop in heart rate, which was managed with vasoactive drugs and glucocorticoids, resulting in recovery after more than ten minutes. This was diagnosed as Kounis syndrome. Conclusion In cases of severe allergic transfusion reactions accompanied by cardiovascular symptoms, it is crucial to consider Kounis syndrome and a comprehensive cardiac evaluation is warranted to ensure timely diagnosis and treatment.

Key words: Allergic, Transfusion reaction, Kounis syndrome, Sudden decrease in heart rate

中图分类号:

R457

邵明, 孔永奎, 李慧娟, 田爱华, 田文亮, 周帅, 张青青, 杨乾坤. 一例过敏性输血反应疑似诱发Kounis综合征引起心率骤降的病例及文献分析[J]. 临床输血与检验, 2025, 27(1): 83-88.

SHAO Ming, KONG Yongkui, LI Huijuan, TIAN Aihua, TIAN Wenliang, ZHOU Shuai, ZHANG Qingqing, YANG Qiankun. A Case Report and Literature Analysis of Allergic Blood Transfusion Reaction Suspected to Induce Kounis Syndrome and Cause Sudden Heart Rate Drop[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2025, 27(1): 83-88.

参考文献

[1] GIOVANNINI M,KONIARI I,MORI F,et al.Kounis syndrome:towards a new classification[J].Int J Cardiol,2021,341:13-14.
[2] KOUNIS N G,KONIARI I,VELISSARIS D,et al.Kounis syndrome—not a single-organ arterial disorder but a multisystem and multidisciplinary disease[J].Balkan Med J,2019,36(4):212-221.
[3] 中华人员共和国卫生健康委.输血不良反应分类[S].2018.
[4] DIAZ-RODRIGUEZ P E,MOLINA-LOPEZ V H,GONZALEZ BURGOS B A,et al.A rare case of kounis syndrome secondary to infliximab[J].Cureus,2023,15(9):e44704.
[5] KOUNIS N G.Kounis syndrome:an update on epidemiology,pathogenesis,diagnosis and therapeutic management[J].Clin Chem Lab Med,2016,54(10):1545-1559.
[6] FORZESE E,PITRONE C,CIANCI V,et al.An insight into kounis syndrome:bridging clinical knowledge with forensic perspectives[J].Life(Basel),2024,14(1):91.
[7] GOTO M,MATSUZAKI M,FUCHINOUE A,et al.Chronic atherosclerotic mesenteric ischemia that started to develop symptoms just after anaphylaxis[J].Case Rep Gastroenterol,2012,6(2):300-308.
[8] KOUNIS N G,KONIARI I,PLOTAS P,et al.Bee sting-induced acute ischemic stroke:a new manifestation of kounis syndrome?[J].Ann Indian Acad Neurol,2021,24(1):118-120.
[9] SHANKAR T,VEMPALLI N,ASOKAN R,et al.Stroke in a patient of anaphylaxis-a case report and brief review[J].Int J Emerg Med,2023,16(1):74.
[10] DESAI R,PAREKH T,PATEL U,et al.Epidemiology of acute coronary syndrome co-existent with allergic/hypersensitivity/anaphylactic reactions(Kounis syndrome)in the United States:a nationwide inpatient analysis[J].Int J Cardiol,2019,292:35-38.
[11] Akoz A,Tanboga H I,Emet M,et al.A prospective study of kounis syndrome: Clinical experience and cardiac magnetic resonance imaging findings for 21 patients[J].Acta Medica Mediterranea,2013,29(4):811-816.
[12] KUMARAN T,DAMODARAN S,SINGH A P,et al.Intraoperative cardiac arrest due to allergic acute coronary syndrome(Kounis syndrome)triggered by cephalosporin[J].Ann Card Anaesth,2023,26(2):219-222.
[13] YASUI K,MATSUYAMA N,TAKIHARA Y,et al.New insights into allergic transfusion reactions and their causal relationships,pathogenesis,and prevention[J].Transfusion,2020,60(7):1590-1601.
[14] GOGOS C,STAMOS K,TSANAXIDIS N,et al.Blood transfusion components inducing severe allergic reactions:the first case of kounis syndrome induced by platelet transfusion[J].Vaccines(Basel),2023,11(2):220.
[15] BADAMI K G.Transfusion double whammy? Adrenaline-takotsubo-anaphylaxis-Kounis complex post transfusion?[J].Vox Sang,2022,117(6):862-865.
[16] 中国心电学会,中国心律学会.心电图标准化和解析的建议与临床应用国际指南2009[M].北京:中国环境科学出版社,2009.
[17] OLLO-MORALES P,GUTIERREZ-NISO M,DE-LA-VIUDA-CAMINO E,et al.Drug-induced kounis syndrome:latest novelties[J].Curr Treat Options Allergy,2023:1-18.
[18] POGGIALI E,BENEDETTI I,VERTEMATI V,et al.Kounis syndrome:from an unexpected case in the Emergency Room to a review of the literature[J].Acta Biomed,2022,93(1):e2022002.
[19] YANAGAWA Y,KONDO A,ISHIKAWA K,et al.Kounis syndrome should be excluded when physicians treat patients with anaphylaxis[J].Ann Allergy Asthma Immunol,2017,119(4):392.

一例过敏性输血反应疑似诱发Kounis综合征引起心率骤降的病例及文献分析

A Case Report and Literature Analysis of Allergic Blood Transfusion Reaction Suspected to Induce Kounis Syndrome and Cause Sudden Heart Rate Drop

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

关于本刊

作者中心

在线期刊

访问统计

联系我们

[1]	刘曦, 沈雨青, 孙瑛, 张玉宇, 朱心怡, 向东. 流式方法检测患者红细胞上IgA、IgG类抗体的临床意义[J]. 临床输血与检验, 2025, 27(1): 54-58.
[2]	陈旭升, 杨永涛. 静脉输注丙种球蛋白对非新生儿溶血患儿交叉配血的影响[J]. 临床输血与检验, 2023, 25(6): 749-752.
[3]	施艺璇, 何苏英, 彭永正. 电子匹配信息系统辅助的Rh血型五抗原配合性输注的安全性和有效性研究[J]. 临床输血与检验, 2023, 25(3): 379-383.
[4]	周姗姗, 荆亚楠, 侯晓燕, 薛亚飞, 张媛媛, 黄霞, 王敏. 某三甲医院2021~2022年276例输血不良反应回顾性分析^*[J]. 临床输血与检验, 2023, 25(1): 38-43.
[5]	向东, 范亮峰, 刘曦, 沈伟, 郑皆炜, 谢军华, 王中英, 金沙, 陆琼, 姜跃勤, 张玉宇. 免疫性溶血性输血反应100例分析*[J]. 临床输血与检验, 2022, 24(1): 11-15.
[6]	王巍东, 王晶晶, 李闯, 申家辉, 李志强. FOCUS-PDCA循环法在输血反应上报中的应用*[J]. 临床输血与检验, 2022, 24(1): 88-92.
[7]	韦海春, 宁冈, 梁玉君, 梁志东, 郑敏. 重型β地中海贫血患者随机输注RhC、c、E、e血型血液情况的初步研究^*[J]. 临床输血与检验, 2020, 22(6): 621-623.
[8]	袁婷婷, 张锐锋, 商巧雨. 紫癜性肾炎患儿血清APN、CysC、OPN 和IgA1水平分析[J]. 临床输血与检验, 2019, 21(6): 623-625.
[9]	周芳竹, 朱传琳, 兰炯采, 张娟. 中药在抑制补体活性及溶血反应中的作用^*[J]. 临床输血与检验, 2019, 21(3): 229-232.
[10]	王姣杰, 单泓, 安慧娟, 别立莉, 张玉红. 某地区2016年度输血不良反应分析[J]. 临床输血与检验, 2018, 20(6): 609-611.
[11]	屈柯暄,宝福凯,柳爱华. 儿童输血不良反应相关因素分析*[J]. 临床输血与检验, 2018, 20(4): 384-386.
[12]	王惟, 李玲玲, 柴婷婷, 刘祥君, 李云强. 去白细胞成分血质量对降低输血不良反应的影响^*[J]. 临床输血与检验, 2018, 20(2): 126-128.
[13]	王丽莉, 杜平. 免疫产生迟发型溶血性输血反应的分析[J]. 临床输血与检验, 2018, 20(2): 185-188.
[14]	刘丽娟, 杜肖刚, 王丽荣, 武洪琳. 输血前预防性用药对输血不良反应的影响[J]. 临床输血与检验, 2017, 19(6): 559-561.
[15]	杨园园, 林正明. 抗-E抗体导致迟发型溶血性输血反应1例[J]. 临床输血与检验, 2017, 19(6): 639-640.