难治性贫血与巨幼细胞贫血、再生障碍性贫血的细胞形态学对比分析
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摘要
目的:探讨骨髓异常增生综合征难治性贫血(MDS-RA)与巨幼细胞贫血(MA)、再生障碍性贫血(AA)的细胞形态学特征。方法:回顾分析80例MDS-RA、198例MA和100例AA的血常规、外周血细胞形态、骨髓涂片、骨髓病理活检及骨髓细胞铁染色的特点。结果:三者均表现为不同程度的血细胞减少,血片可见幼稚细胞及有核红细胞,骨髓内外铁不同程度的增加,MDS-RA骨髓中红系以中、晚幼红的巨幼变为主(61.3%),出现多核、核碎裂、毫周氏小体。MA骨髓中,红系各个阶段均增生,以早幼红、中幼红及晚幼红的巨幼变为主(95%)。AA骨髓中红系以炭核样红细胞增生为主。MDS-RA和MA粒系均表现出骨髓象病态造血,粒系表现为核浆发育失衡,出现巨晚幼、巨杆状核、细胞核肿胀、多分叶核、环状核,26.3%的MDSRA巨幼样变和畸形核比例明显低于MA(95%)。MDS-RA巨核系出现巨大血小板及淋巴样小巨核细胞,MA巨核细胞体积增大,核质疏松,多呈分叶型,胞质内颗粒减少,并且能见到小巨核细胞,但未见到淋巴样的小巨核细胞。低增生的MDS-RA与AA骨髓病理活检涂片区别明显。结论:MDS-RA与MA、AA虽然细胞形态具有相似性,但又具有各自的不同特征。这些特征为这三种疾病的诊断和鉴别提供了依据和线索。
Objective: To investigate the morphological features of myelodysplastic syndrome- refractory anemia( MDS- RA),megaloblastic anemia( MA) and aplastic anemia( AA). Methods: To retrospectively analyze the characteristics of blood,peripheral blood cell morphology,bone marrow smears,bone marrow biopsy and bone marrow cells iron stain in 80 cases of MDS- RA,198 cases of MA and 100 cases of AA. Results: Three kinds of diseases showed the different degrees of cytopenias. Peripheral blood smear observed immature and nucleated red blood cells. The level of iron in cells and out of cells by marrow iron- stain were detected. Erythrocyte of MDS- RA was proliferated mainly on giant infant of intermediate or late erythroblasts cells( 61. 3%),appeared multinucleate cell,karyorrhexis and zhou corpuscle. In MA bone marrow,all stages of the erythrocyte series were proliferated,and mainly on the giant infant of the young red( 95%),intermediate or late erythroblasts cells. In AA bone marrow,erythrocyte series were proliferated mainly on red blood cells which nuclei were like charcoal. The bone marrow of MDS- RA and MA have showed dyshaematopoiesis. Granulocyte series showed karyoplasmic development imbalance,appeared giant branch metamyelocyte,giant rod nuclear cells,swelling nuclei,many leaves nuclei and ring shaped nuclei. The giant infant of MDS- RA( 26. 3%) was significantly lower than that of MA( 95%). MDS- RA had megakaryocyte with giant platelets and lymphoid micromegakaryocyte. Volume of MA megakaryocyte cell was increased,with karyoplasms loose,leaves type,the reduced particle in the cytoplasm. Micromegakaryocytes were also observed,but not the lymphoid micromegakary-ocytes. The difference between hypoplastic MDS- RA and AA in bone marrow biopsy smear was obvious. Conclusion: MDS- RA,AA and MA were similar in morphology,but they had different characteristics,which provided the basic clues for diagnosing these three diseases.
Objective: To investigate the morphological features of myelodysplastic syndrome- refractory anemia( MDS- RA),megaloblastic anemia( MA) and aplastic anemia( AA). Methods: To retrospectively analyze the characteristics of blood,peripheral blood cell morphology,bone marrow smears,bone marrow biopsy and bone marrow cells iron stain in 80 cases of MDS- RA,198 cases of MA and 100 cases of AA. Results: Three kinds of diseases showed the different degrees of cytopenias. Peripheral blood smear observed immature and nucleated red blood cells. The level of iron in cells and out of cells by marrow iron- stain were detected. Erythrocyte of MDS- RA was proliferated mainly on giant infant of intermediate or late erythroblasts cells( 61. 3%),appeared multinucleate cell,karyorrhexis and zhou corpuscle. In MA bone marrow,all stages of the erythrocyte series were proliferated,and mainly on the giant infant of the young red( 95%),intermediate or late erythroblasts cells. In AA bone marrow,erythrocyte series were proliferated mainly on red blood cells which nuclei were like charcoal. The bone marrow of MDS- RA and MA have showed dyshaematopoiesis. Granulocyte series showed karyoplasmic development imbalance,appeared giant branch metamyelocyte,giant rod nuclear cells,swelling nuclei,many leaves nuclei and ring shaped nuclei. The giant infant of MDS- RA( 26. 3%) was significantly lower than that of MA( 95%). MDS- RA had megakaryocyte with giant platelets and lymphoid micromegakaryocyte. Volume of MA megakaryocyte cell was increased,with karyoplasms loose,leaves type,the reduced particle in the cytoplasm. Micromegakaryocytes were also observed,but not the lymphoid micromegakary-ocytes. The difference between hypoplastic MDS- RA and AA in bone marrow biopsy smear was obvious. Conclusion: MDS- RA,AA and MA were similar in morphology,but they had different characteristics,which provided the basic clues for diagnosing these three diseases.
引文
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[16]Ren Jianping,Xi Zhenfang,Cao Shuwei.Bone marrow biopsy and bone marrow smear synchronous analysis of blood disease diagnosis[J].Leukemia·Lymphoma,2010,19(3):180-181.[任建平,席振芳,曹淑伟.骨髓活检与骨髓涂片同步分析对血液病诊断的探讨[J].白血病·淋巴瘤,2010,19(3):180-181.]
[2]Ghariani I,Braham N,Hassine M,et al.Myelodysplastic syndrome classification[J].Ann Biol Clin,2013,71:139-144.
[3]Garcia-Manero G.Myelodysplastic syndromes:2014 update on diagnosis,risk-stratification,and management[J].Am J Hematol,2014,9(1):97-108.
[4]Ali Bay,Mehmet Keskin,Samil Hizli,et al.Thiamine-responsive megaloblastic anemia syndrome[J].International J Hematology,2010,92(3):524-526.
[5]Zhang Liying,Chen Pu,Peng Yusheng,et al.Retrospectively analyzed of 500 cases anemia patients with bone marrow cytology examination[J].Clinical Laboratory Medicine,2011,08(22):2742-2743.[张立营,陈朴,彭宇生,等.500例贫血患者骨髓细胞学检查结果回顾性分析[J].检验医学与临床,2011,08(22):2742-2743.]
[6]Bao Shuzhen,Zhang Rufeng,Wu Wenying,et al.Clinical identification and diagnosis of refractory anemia and gigantic young cell anemia[J].Modern Preventive Medicine,2011,38(18):3810-3811.[包淑贞,张如峰,吴文英,等.难治性贫血与巨幼细胞性贫血的临床鉴别与诊断[J].现代预防医学,2011,38(18):3810-3811.]
[7]Jia Hongying.Comparison analysis of the bone marrow and blood cells morphological of myelodysplastic syndrome and anaemic disease[J].Modern Chinese Doctor,2014,52(21):61-63.[贾红英.骨髓增生异常综合征与贫血性疾病骨髓及血细胞形态学比较分析[J].中国现代医生,2014,52(21):61-63.]
[8]Li Fang,Bai Jie,Pu Wenhua.Diagnostic value of jointing bone marrow biopsy and bone marrow smear in myelodysplastic syndrome[J].China Laboratory Diagnosis,2011,15(3):508-510.[李芳,白洁,朴文花.骨髓涂片联合骨髓活检对骨髓增生异常综合征的诊断价值探讨[J].中国实验诊断学,2011,15(3):508-510.]
[9]Lei Ting.The diagnostic value of bone marrow biopsy in blood reduced patients[J].Contemporary Medical,2015,21(3):32-33.[雷婷.骨髓活检对全血细胞减少患者的诊断价值探讨[J].当代医学,2015,21(3):32-33.]
[10]Dong Yi,Zhu Taigang,Li Yuehong,et al.Application value of bone marrow pathologic examination in the blood cells reduce disease[J].Chinese General Medicine,2013,11(2):189-191.[董毅,朱太岗,李月红,等.骨髓病理检查在全血细胞减少性疾病中的应用价值[J].中华全科医学,2013,11(2):189-191.]
[11]Dong Changhu,He Chunling,Wang Yueyue,et al.Classification research of aplastic anaemia marrow pathology[J].Shaanxi Medical J,2011,40(6):721-723.[董昌虎,何春玲,王越月,等.再生障碍性贫血骨髓病理分型研究[J].陕西医学杂志,2011,40(6):721-723.]
[12]Lu Zaiying,Zhong Nanshan.Internal medicine[M].Beijing:People's Medical Publishing House,2008:231-236.[陆再英,钟南山.内科学[M].北京:人民卫生出版社,2008:231-236.]
[13]Hu Minglin.The application of differential diagnosis inspection of bone marrow morphology the in refractory anemia and gigantic young cell anemia[J].International J Laboratory Medicine,2013,34(13):1759-1761.[胡明林.骨髓形态检验在难治性贫血与巨幼细胞性贫血鉴别诊断中的应用[J].国际检验医学杂志,2013,34(13):1759-1761.]
[14]Zhou Gechen.Cell morphology analysis of gigantic young cell anaemia and refractory anemia[J].Jilin Medical,2011,32(16):3311-3312.[周格琛.巨幼细胞贫血与难治性贫血的细胞形态学分析[J].吉林医学,2011,32(16):3311-3312.]
[15]Dong Yi,Zhu Taigang,Xai Ruixiang,et al.Between bone marrow mesenchymal stem cell research for the treatment of aplastic anemia[J].Chinese General Medicine,2009,7(6):552-554.[董毅,朱太岗,夏瑞祥,等.骨髓间充质干细胞治疗再生障碍性贫血的研究[J].中华全科医学,2009,7(6):552-554.]
[16]Ren Jianping,Xi Zhenfang,Cao Shuwei.Bone marrow biopsy and bone marrow smear synchronous analysis of blood disease diagnosis[J].Leukemia·Lymphoma,2010,19(3):180-181.[任建平,席振芳,曹淑伟.骨髓活检与骨髓涂片同步分析对血液病诊断的探讨[J].白血病·淋巴瘤,2010,19(3):180-181.]