骨髓形态差异在巨幼细胞性贫血与难治性贫血鉴别诊断中的临床意义

发布时间：2018-05-06 23:13

本文选题：巨幼细胞性贫血 + 难治性贫血　；参考：《中国实验血液学杂志》2016年03期

【摘要】：目的:探讨骨髓形态差异在巨幼细胞性贫血与难治性贫血鉴别诊断中的临床意义。方法:收集海口市第三人民医院2004年4月至2015年4月收治的60例贫血患者,依照临床诊断分为巨幼细胞性贫血组(megaloblastic anemia,M A)和难治性贫血组(refractory anemia,RA),每组30例。对比两组患者临床表现、骨髓形态、血象检查及外周血涂片结果、红系巨幼变率及有核红细胞数。结果:MA组患者出现发热、出血、消化系反应、脾大、疲乏无力、淋巴结肿大等临床表现率、血红蛋白、血小板及白细胞含量与RA组相似,两组组间比较差异无统计学意义(P0.05);M A组患者红系病态、粒系病态、幼稚粒细胞、淋巴样小巨核百分率、PAS阳性率及红细胞分布宽度均明显低于RA组(P0.05),而红系巨幼变率(90.00%)明显高于RA组(10.00%)(P0.05),而MA组幼稚红细胞百分率(53.33%)与RA组接近(60.00%)。结论:巨幼细胞性贫血与难治性贫血患者大多数临床表现、外周血涂片结果较为一致,RA组骨髓形态检验在诊断时应重点观察淋巴样小巨核细胞,而在MA组则应强调红系巨幼变的胞体,有核红细胞百分率(PAS)可作为临床诊断参考。
[Abstract]:Objective: to investigate the clinical significance of bone marrow morphology difference in differential diagnosis of megaloblastic anemia and refractory anemia. Methods: sixty patients with anemia were collected from April 2004 to April 2015 in the third people's Hospital of Haikou City. According to the clinical diagnosis, they were divided into megaloblastic anemiaAA group and refractory anemia group (30 cases in each group). The clinical manifestations, bone marrow morphology, hematologic examination and peripheral blood smear results, erythroid megaclastic rate and nucleated red blood cell count were compared between the two groups. Results the clinical manifestations, such as fever, hemorrhage, digestive system reaction, splenomegaly, fatigue, lymphadenopathy, hemoglobin, platelet and white blood cell contents, were similar to those in RA group. There was no significant difference between the two groups in erythroid, granulocytic and immature granulocytes. The positive rate of pas and the distribution width of red blood cells in lymphoid micronuclei were significantly lower than those in RA group (P 0.05), while the erythroid megaloblastic degeneration rate was significantly higher than that in RA group (10.00%), while the percentage of immature erythrocytes in MA group (53.33%) was close to 60.005% in RA group. Conclusion: most of the clinical manifestations of patients with megaloblastic anemia and refractory anemia are consistent with the results of peripheral blood smear. In RA group bone marrow morphologic examination should focus on the observation of lymphoid megakaryocyte in diagnosis. In MA group, the cell body of erythroid megaloblastic degeneration should be emphasized, and the percentage of nucleated red blood cells (PAS) could be used as a reference for clinical diagnosis.
【作者单位】：海口市第三人民医院检验科;中国人民解放军187医院检验科;中山大学孙逸仙纪念医院血液内科;
【分类号】：R556;R446.11

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