骨髓呈再生障碍性贫血样表现的低增生性白血病  

Hypocellular Acute Leukemia Characteriged by Aplastic Anemia in Bone Marrow

作　　者：陈勤[1] 汤屹[2] 孟力[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院第二临床学院,武汉430030 [2]华中科技大学同济医学院附属同济医院血液科,武汉430030

出　　处：《临床误诊误治》2012年第1期11-14,共4页Clinical Misdiagnosis & Mistherapy

基　　金：湖北省自然科学基金(2005ABA150)

摘　　要：目的探讨低增生性白血病与再生障碍性贫血的鉴别诊断要点,以减少误诊。方法回顾性分析我院收治的1例低增生性白血病的临床资料。结果本例因反复牙龈出血2年,皮肤淤斑1个月入院。首次行骨髓穿刺(骨穿)及活检提示再生障碍性贫血可能,再次行骨穿及活检提示急性单核细胞白血病可能,后经流式细胞仪检测与多次多部位骨穿及活检确诊为低增生性白血病,予预激方案化疗两疗程,患者骨髓象未缓解,放弃治疗自动出院。结论临床上低增生性白血病与再生障碍性贫血表现相似,易混淆。对可疑患者行外周血涂片同时,需结合多次多部位骨穿及活检的多项检查结果进行综合判断,以避免误诊。Objective To discuss the key points of differential diagnosis between hypocellular acute leukemia and aplastic anemia to reduce misdiagnosis rate. Methods Retrospective analysis of a case of hypocellular acute leukemia was made. Results In this case, the patient suffered gum bleeding for 2 years continuously, and was admitted one month after echymosis in skin occurred. His bone marrow histology showed aplastic anemia for the first time. But it showed acute monocytic leukemia for the second time in bone marrow histology examination. After diagnosis of bone marrow histology and biopsy and flow cytometry, it was con- firmed as hypocellular acute leukemia, and he was given HAG for courses of treatment. The bone marrow did not present complete remission, and the patient gave up treatment and was discharged. Conclusion The manifestation of hypocellular acute leukemia and aplastic anemia are similar, and sometimes it is difficult to differentiate. So we have to do several examinations including peripheral blood smear, bone marrow smear and biopsy, flow cytometry and cytogenties. And the bone marrow puncture should be done in different points in the patients. Synthetical diagnosis should be made to avoid misdiagnosis.

关 键 词：白血病 贫血 再生障碍性 误诊 鉴别 诊断 

分 类 号：R733.73[医药卫生—肿瘤]