结合WHO诊断标准浅谈骨髓细胞形态学在骨髓增生异常综合征诊断中的意义  

Significance of bone marrow cytomorphology in the diagnosis of myelodysplastic syndrome combined with the WHO diagnostic criteria

作　　者：陈万新[1] CHEN Wanxin(Institute of Hematology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院血液病学研究所,武汉430022

出　　处：《临床血液学杂志》2022年第11期826-830,共5页Journal of Clinical Hematology

摘　　要：按照WHO标准,主要依靠外周血细胞减少、细胞形态学(骨髓细胞病态造血、环形铁粒幼红细胞计数、原始细胞比例)、细胞遗传学核型分析,对骨髓增生异常综合征(MDS)进行诊断和分型。重要的辅助诊断包括骨髓病理活检或(和)免疫组织化学、流式细胞免疫表型和MDS相关基因突变的检测。病态造血是MDS诊断分型的形态学基础,原始细胞不增多的MDS主要依靠病态造血进行诊断分型。病态造血巨核细胞≥10%或环状铁粒幼红细胞≥15%,对MDS具有较确定性的诊断意义。部分MDS-SLD及MDS-MLD,巨核细胞系无病态造血,仅有红细胞系和(或)粒细胞系病态造血细胞的比例≥10%,属于真正意义上的MDS最低诊断标准,在实际操作起来难以准确把握,诊断MDS时应慎重,并需排除反应性病态造血。该文详细介绍了细胞形态学对MDS的诊断意义,详细解读了各系病态造血的细胞形态学特征以及笔者的经验和体会,分析总结了MDS的诊断思路,阐述了MDS诊断中应注意的问题,对于MDS的精准诊断及防止误诊具有建设性意义。According to WHO criteria,the diagnosis and classification of myelodysplastic syndrome(MDS)mainly depends on peripheral blood cytopenia,cytomorphology(dysplasia of bone marrow,ring sideroblast count,proportion of blasts),and cytogenetic karyotype analysis.Important auxiliary diagnosis includes bone marrow biopsy or(and)immunohistochemistry,flow cytometry immunophenotype and MDS related gene mutation detection.Dysplasia is the morphological basis of MDS diagnosis and classification.The diagnosis and classification of MDS without excess blasts mainly depends on dysplasia.Dysmegakaryopoiesis≥10%or ring sideroblasts≥15%,which is of definite diagnostic significance for MDS.Some MDS-SLD and MDS-MLD have no dysplasia of megakaryocytes,and only have erythroid or(and)neutrophilic lineage with dysplasia cells≥10%,which is actually minimal diagnostic criteria of MDS,and it is difficult to accurately grasp in practice.Therefore,we should be careful when diagnosing MDS and exclude reactive dysplasia.In this article,the significance of cytomorphology in diagnosis of MDS is introduced,and the morphological characteristics of dysplasia and the author’s experience are interpreted.The diagnostic ideas of MDS are analyzed and summarized,and the announcements of diagnosis MDS are expounded,which is of constructive significance for accurate diagnosis of MDS and prevention of misdiagnosis.

关 键 词：骨髓增生异常综合征 细胞形态学 病态造血 诊断标准 分型 

分 类 号：R733[医药卫生—肿瘤]