异基因外周造血干细胞移植后并发巨幼细胞性贫血二例及文献复习  

Allogeneic peripheral blood stem cell transplantation complicated with megaloblastic anemia: two cases report and literatures review

作　　者：姜艳红 陈光意 盛家和 许青霞 Jiang Yanhong;Chen Guangyi;Sheng Jiahe;Xu Qingxia(Clinical Laboratory, the Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China)

机构地区：[1]郑州大学附属肿瘤医院检验科,450008

出　　处：《中华器官移植杂志》2018年第10期615-619,共5页Chinese Journal of Organ Transplantation

摘　　要：目的结合2例异基因造血干细胞移植后并发巨幼细胞性贫血受者病历对相关文献进行复习。方法回顾性分析2例异基因造血干细胞移植后并发巨幼细胞性贫血受者病历,通过血象、骨髓象、细胞化学染色、骨髓活检和免疫分型确诊原发病,移植后,通过骨髓细胞形态学检查,叶酸和维生素B12检测确诊巨幼细胞贫血。结果例1移植后32 d行骨髓穿刺术,有核细胞增生活跃,粒系增生活跃,可见巨杆状核粒细胞;红系增生活跃,各阶段幼红细胞比例增高,多数呈巨幼变,幼红细胞核、浆发育不平衡,巨细胞可见,血小板散在可见。查叶酸和维生素B12,均远低于参考范围,补充叶酸和维生素B12 2周后,复查血常规,红细胞体积恢复正常,复查骨髓象,巨幼变细胞消失。例2移植3个月后骨髓穿刺示:有核细胞增生活跃,粒系增生减低,可见巨杆状核粒细胞;红系增生活跃,晚幼红细胞比例增高,多数呈巨幼变;巨细胞偶见,血小板散在少见。查叶酸和维生素B12,叶酸远低于参考范围,维生素B12在参考范围内,补充叶酸和维生素B12 2周后,复查血常规,红细胞体积恢复正常,复查骨髓象,巨幼变细胞消失。结论异基因造血干细胞移植后受者要注意体内叶酸和维生素B12量的检测,不足时及时补充,避免巨幼细胞性贫血的发生。Objective Combined with the medical records of two patients with megaloblastic anemia (MA) after allogeneic hematopoietic stem cell transplantation (AHSCT), the relevant literature was reviewed. Methods The medical records of two patients with MA after AHSCT were analyzed retrospectively. The primary disease was diagnosed by analyzing the blood cells, bone marrow cell morphology, cell chemical dyeing, bone marrow biopsy and immune classification. After AHSCT, MA was diagnosed through bone marrow cell morphology, folic acid and vitamin B12 detection. Results AT 32nd day after transplantation, bone marrow cells morphological examination of case 1 showed: nucleated cells proliferation activity, granulocytes proliferation activity, giant rod nucleus granulocytes visible;different stages of the red blood cells proliferation activity, higher proportion of immature red blood cells, most of whose nucleus developed later than the cytoplasm;megakaryocytes and platelets scattered distribution. Blood contents of folic acid and VB12 were far below the reference range. After administration of folic acid and VB12 for 2 weeks, routine blood test showed the volume of red blood cells returned to normal. Re-examination of bone marrow cell morphology showed megaloblastic cells disappeared. Three months after transplantation, bone marrow cells morphological examination in case 2 showed: nucleated cells proliferation activity, low granulocytes proliferation, giant rod nucleus granulocytes visible;different stages of the red blood cells proliferation activity, higher proportion of orthochrmatic normoblasts, most of whose nucleus developed later than the cytoplasm;scattered distribution of megakaryocytes and platelets. Blood contents of folic acid were far below the reference range, but the content of VB12 was normal. After administration of folic acid and VB12 for 2 weeks, the routine blood test showed the volume of red blood cells returned to normal. The re-examination of bone marrow cell morphology showed megaloblastic cells disappea

关 键 词：造血干细胞移植 贫血 巨幼细胞性 叶酸 

分 类 号：R457.7[医药卫生—治疗学] R556[医药卫生—临床医学]