骨髓形态学结合外周血象检查对全血细胞减少性疾病的诊断意义  

作　　者：徐坚强 舒文秀 乐静 

机构地区：[1]宁波市李惠利医院,315010

出　　处：《浙江临床医学》2013年第6期818-820,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨骨髓象形态学结合外周血形态特征分析对全血细胞减少性疾病的病因及疾病特点。方法对初诊228例全血细胞减少症患者的骨髓形态学及外周血象进行分析。结果228例患者中，造血系统疾病占79.4%，急性白血病25%，再生障碍性贫血17.5%，MA14%，MDS7.5%，IDA6.6%，ITP4.4%，MM和HA各1.8%，骨髓坏死和淋巴瘤各0.4%；非造血系统疾病占20.6%，脾亢11.4%，IRP3.9%，感染性疾病（伤寒2例）和骨髓转移性肿瘤各2.6%。造血系统疾病三系血细胞减少多表现为中重度，非造血系统疾病多为轻中度，特别是在红细胞、血小板减少程度及贫血程度差异有统计学意义（P〈0.01）；MCV对于大细胞性贫血患者有一定的临床鉴别意义，特别与MDS、AA的鉴别，与其他红细胞指数有一定重叠性。结论全血细胞减少性疾病广泛，病因复杂，多为造血系统疾病引起，骨髓细胞形态学联合红细胞检查有重要的诊断价值。Objective To assess the etiological pattern, clinical profile of 228 pancytopenia patients. Methods Peripheral blood pictures and bone marrow morphologies and the etiological pattern were assessed through the relevant investigation in the respective patients. Results 1.Among 228 patients who had pancytopenia, 79.4%were from hematopoietic diseases, acute leukemia （25.0%） aplastic anemia （ AA 17.5% ） , megaloblastic anemia （ MA 14% ） , myelodysplastic syndromes （ MDS 7.5% ） , iron deficient anemia （ IDA 6.6% ） , idiopathic thrombocytopenic purpura （ ITP 4.4% ） , multiple myeloma （ MM 1.8% ） , hemolytic anemia （ HA 1.8% ） , lymphoma and bone marrow necrosis （ 0.4% ） , non-hematological causes included hypersplenia （ 11.4% ） , immunorelated pancytopenia （ 3.9% ） , infections including 2 typhoid fever patients （ 2.6 % ） , tumor cell of bone marrow involvement （ 2.6 % ） .2.Pancytopenia patients from hematological diseases groups always displayed moderate or severe cell reduction, while in nonhematopoietic groups, the cell reduction was mild or moderate. 3. Mean corpuscular volume （ MCV ） was important to distinguish macrocytic anemia, it had statistical significance in distinguishing the MA from the MDS or AA. Conclusions Pancytopenia is a common occurrence, hematological diseases are the usual causes of pancytopenia, Combining bone marrow examination with peripheral blood pictures is of great value in the diagnosis of pactyopenia.

关 键 词：全血细胞减少 骨髓细胞形态学 红细胞平均容积 

分 类 号：R55[医药卫生—血液循环系统疾病]