儿童急性白血病误诊二例原因分析  

Cause Analysis of Misdiagnosis and missed Diagnosis of 2 Cases of Childhood Acute Leukemia

作　　者：王衍晶[1] 刘艳[1] 王贞[1] 

机构地区：[1]大连医科大学附属第一医院检验科,辽宁大连116011

出　　处：《临床误诊误治》2015年第3期15-18,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨儿童急性白血病的临床特点,分析误诊原因并提出防范措施。方法回顾分析我院2012—2013年收治并误诊的儿童急性白血病2例的临床资料。结果本文例1因间断髋关节疼痛1个月、加重并发热5 d就诊,疼痛可自行缓解并反复出现,于外院影像学检查诊断为髋关节滑膜炎,予抗感染治疗无好转,我院门诊按儿童类风湿病(多关节型)予抗风湿治疗,热退疼痛缓解,但仍有多关节活动受限。为系统治疗收入我院儿科,入院后诊断为全身型幼年特发性关节炎,予对症治疗症状缓解,复查血常规发现原始及幼稚细胞,行骨髓血细胞形态检查确诊为急性淋巴细胞白血病。例2因发热、盗汗、乏力6 d,其间伴少量鼻出血3 d就诊,予退热及抗感染治疗好转,后症状反复出现,入院后按上呼吸道感染予对症治疗无效。复查血常规发现原始细胞,经骨髓血细胞形态检查确诊为急性淋巴细胞白血病。结论对久治不愈的发热、骨痛、感染的患儿要警惕白血病,尽早行骨穿血细胞形态学检查是明确诊断的关键。Objective To explore the clinical characteristics of childhood acute leukemia, analyzes the causes of mis-diagnosis and missed diagnosis and put forward the preventive measures. Methods Retrospective analysis of clinical data of 2 cases of misdiagnosis and missed diagnosis of childhood acute leukemia admitted during 2012-2013 combined with literature a-nalysis were made. Results Case 1 had intermittent hip pain for 1 month and fever for 5 days. The pain was alleviated by it-self but relapsed. The patient was diagnosed as having synovitis of the hip in the other hospital＆#39;s imaging and was given anti -inflammatory therapy without any improvement. In our outpatient department, the patient was diagnosed as having childhood rheumatism （multi-joint type） and was given anti - rheumatism treatment. The fever and pain were relieved, but there were still limited movement in many joints. After admission the patient was diagnosed as having systemic juvenile idiopathic arthri-tis. Re-examination of blood routine analysis showed blast cells. Bone marrow morphological examination suggested acute lym-phoblastic leukemia. Case 2 had fever, night sweat and fatigue for 6 days and a small amount of nasal bleeding for 3 days. He was given antifebrile and anti-infection therapy. The symptoms relapsed. After hospitalization, the patient was diagnosed as having upper respiratory tract infection. Review of blood routine test found blast cells, and bone marrow morphological exami-nation also suggested with acute lymphoblastic leukemia. Conclusion We should be alert for childhood leukemia if fever, pain of bone and infection have no improvement in patients after treatment. The crucial measure is to take bone marrow aspira-tion for morphological examination in order to make accurate diagnosis.

关 键 词：白血病 淋巴样 儿童 骨痛 误诊 滑膜炎 上呼吸道感染 

分 类 号：R733.71[医药卫生—肿瘤]