OBJECTIVE: To explore the role of clinical pharmacists in the process of drug treatment for leukemia children with neutrophil deficiency complicated with fever (NDCF). METHODS: Clinical pharmacists participated in the treatment for a leukemia child with NDCF. Considering about continuous decrease of platelet accompanied by epistaxis, combined with age, clinical symptom, lab indexes and related guidelines, clinical pharmacists thought it was possibly associated with bone marrow induced by chemotherapy drugs and drug-induced hemorrhage induced by cefoperazone sodium and sulbactam sodium. It was suggested to stop using cefoperazone sodium and sulbactam sodium; use Meropenem for injection 1.0 g, ivgtt, q8 h instead for anti-infection; additionally use Recombinant human thrombopoietin injection 15 000 U,sc,qd for elevating platelet. During treatment, taking into account the low levels of neutrophils (0.17×109 L-1) and platelets (11×109 L-1) in this child, it was recommended to continue anti-infection and elevating platelet treatment, and continue to use Lienal polypeptide injection to auxiliarily enhance hematopoietic function. When the child’s condition was stable and neutrophils returned to normal, it was successively recommended to stop elevating platelet and anti-infection treatment; at the same time, conduct pharmaceutical care as body temperature examination, related indicator examination (such as routine blood test) and ADR monitoring, etc. RESULTS: Physicians adopted the clinical pharmacist’s suggestions. The body temperature of the child was decreased, the hemogram recovered gradually, no infection occurred, and the next round of chemotherapy was successfully carried out. CONCLUSIONS: The clinical pharmacists participate in drug treatment for leukemia children with NDCF, pay attention to the prevention, diagnosis and treatment of drug-induced disease, and make comprehensive analysis by using their own professional advantage, taking the possible effects of drugs on blood system, pharmacodynamics and pharmacokinetic characteristics as the breakthrough point, combing with the specific situation of children’s age and illness; assist physicians to formulate and optimize drug therapy plan so as to guarantee safe and effective drug use.
关键词
临床药师药学监护骨髓抑制中性粒细胞缺乏伴发热白血病儿童
Keywords
Clinical pharmacistsPharmaceutical careBone marrowNeutrophil deficiency complicated with feverLeukemiaChildren
Dept. of Pharmacy, Second Affiliated Hospital, Army Medical University
Dept. of Pharmacy, Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University
Laboratory of Child Development and Disorder,National Clinical Research Center for Child Health and Disorders(Chongqing),China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Children’s Hospital of Chongqing Medical University