多发性骨髓瘤生物学和临床诊治的新视野:第56届美国血液学会年会报道

多发性骨髓瘤(MM)是一种从癌前状态(意义不明的单克隆免疫球蛋白血症MGUS)到恶性疾病转化过程的独特肿瘤.在其发病过程中,肿瘤克隆的基因型特点与浆细胞与其微环境之间的对话同样重要.MM基因是高度复杂和异质性的,它们对疾病的转归起着关键的作用,不久以后MM可能将不再被视为一个单一的疾病.大量新药的应用,将增加对微小残留病监测预后和治疗效果的预期和需要.新药和高剂量化疗联合自体干细胞移植的应用使MM的预后已经在过去20年得到显著改善,重新审视早期MM的诊断标准和早期干预的可能性将开辟新的治疗途径.新药物的不断涌现,将促使人们平衡疗效、毒性和成本之间的关系,以达到最佳的治疗目标.     

血液肿瘤的遗传和先天易感因素值得重视:第56届美国血液学会年会报道

随着研究的进展,越来越多血液肿瘤相关的遗传或先天易感因素被揭示,并成为2014年第56届美国血液学会年会的热点话题.正确地认识和解读这些先天易感因素,对于改进患者的治疗、突变携带者的预防或及早发现肿瘤都有重要意义.文章就目前这方面的研究进展结合作者所在医院的工作经验作以介绍.     

目标导学模式在血液病学教学中的应用及评价

目的:探讨新的教学模式"目标导学"在血液病学教学中的作用。方法:选取2007级临床医学本科4个班128人作为实验组实施"目标导学"教学方法,另外选取同级4个班126人为对照组进行传统教学。通过考试成绩和问卷调查比较两种教学方法。结果:血液系统疾病理论考试,实验组成绩平均分数为89.75±7.72,明显高于对照组83.69±11.28(P=0.015)。问卷调查表明实验组学生优越于对照组。结论":目标导学"的教学模式具有一定优势,值得推广及研究。     

血液病房病原菌分布及耐药性分析

目的 调查血液内科病原菌的分布及耐药趋势,以指导临床合理使用抗菌药物.方法 对2009年1月-2010年11月血液内科住院患者送检的2707份各类标本中分离出的病原菌及药敏结果进行回顾性分析.结果 共分离出病原菌205株,其中革兰阳性菌50株占24.39％,以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主;革兰阴性菌117株占50.07％,以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌为主;真菌38株占18.54％,其中以白色假丝酵母菌和近平滑假丝酵母菌为主;主要标本来源为血液,占83.71％,其次为痰占6.54％;葡萄球菌属中耐甲氧西林菌的检出率高达86.20％,革兰阴性菌株中产ESBLs的阳性率为35.90％;革兰阴性杆菌对碳青霉烯类以及含有酶抑制剂的药物耐药率较低,大肠埃希菌耐药率均较高,而铜绿假单胞菌和肺炎克雷伯菌的耐药率不高.结论 血液病患者最易发生血源性感染,以革兰阴性菌为主,真菌的感染率较高,对疑似合并感染的患者应及时留取标本进行微生物鉴定,并依据药敏试验调整用药,以便有效韵控制感染和防止耐药性的产生.     

Reticulocyte analysis using flow cytometry

Automation of the reticulocyte count by means of flow cytometry has considerably improved the quality of this investigation. This article deals firstly with the reasons for the poor performance of the microscopic technique and with the physiological principles underlying identification and classification of reticulocytes using RNA labeling. It then outlines the automated methods currently on the market, which can be classified in three categories: a) general-purpose cytofluorometers, which in clinical laboratories usually deal with lymphocyte immunophenotyping; b) the only commercially available cytofluorometer dedicated to the reticulocyte count; this automat has the advantage of requiring no human intervention as it merely needs to be fed with samples; c) hematology analyzers with specific modules for automatic counting of reticulocytes previously incubated with a non-fluorescent dye. Of the various fluorescent markers available, thiazole orange, DEQTC iodide and auramine are most often used for this basic hematology test. The quality of the count, the availability of new reticulocyte indices (maturation index, percentage of young reticulocytes) and the rapidity of the count give this test renewed value in the practical approach to the diagnosis of anemia, and also open new perspectives in the surveillance of aplastic anemia after chemotherapy or bone marrow grafting.     

Second primary bronchogenic carcinomas after small cell carcinoma. Report of two cases and review of the literature

Second primary carcinomas of the lung are well described. However, their occurrence following initial diagnosis of small cell lung carcinoma is rare. The development and antemortem diagnosis of metachronous second primary bronchogenic carcinomas in two long-term (more than four years) survivors of small cell lung cancer is described. The histologic types of the second carcinomas were mucoepidermoid and bronchoalveolar. On the basis of a review of the literature, only eight similar cases have been reported; none of the second primaries was mucoepidermoid or bronchoalveolar. The question of whether second primaries after small cell lung cancer represent true metachronous carcinomas, different degrees of differentiation of the same tumor, or the emergence of a previously unrecognized synchronous tumor is discussed. The need for awareness of this complication and the necessity for life-long follow-up in long-term survivors of small cell lung cancer is emphasized.     

Blood collection,platelet isolation and measurement of platelet count and size in mice—a practical guide

Inherited or acquired disorders of platelet production and function can result in thrombocytopenia and bleeding. Mouse models have proven useful for investigating the mechanisms that underlie these defects in humans. Precise methods for blood withdrawal, platelet isolation and measurement of platelet parameters are key for the generation of reproducible and conclusive data.

Here, we provide three different protocols for mouse platelet isolation to encourage research knowledge transfer between experienced laboratories, while at the same time enabling less experienced researchers to implement a protocol that best suits their local expertise and equipment. We also address the issue that reported mouse platelet count and size vary considerably in the literature by investigating different factors that influence these important platelet parameters, namely: 1) genetic background and gender, 2) choice of analysis method (hematological analyzer or flow cytometry), 3) dilution of the blood sample and 4) choice of anticoagulant. The herein presented results and considerations may serve as a practical guide for both experienced and new researchers in the platelet field.     

问题链教学法在血液病教学中的应用

血液病学因涉及基础医学、骨髓细胞形态学等较多内容而成为医学本科生难以掌握的临床课程之一。问题链教学法是以问题串的形式、教师为主导、学生为主体的一种发展性教学方式。在血液病教学中首次引入＂问题链教学法＂,充分调动学生学习的兴趣、主动性、积极性和创新意识,注重培养他们的思维、协作及表达的能力,获得较好的教学效果。本文以白血病为例介绍问题链教学法应用于血液病教学的具体过程,并对其效果及存在的不足进行评价和分析。     

血管性假血友病研究进展

血管性假血友病（简写ｖＷＤ）是最常见的遗传性出血性疾病，临床诊治难度大。本文综述了近几年来运用分子生物学技术，对ｖＷＤ在分型、诊断和治疗方面的进展，提出临床分型对治疗的指导意义。     

HIV感染者的血液学改变及其临床意义

目的 探讨HIV感染者的血液学改变及其临床意义。方法 对HIV感染者进行治疗前的血常规及骨髓细胞形态学检查。结果 HIV感染者外周血细胞减少，白细胞分类表现出淋巴细胞减少、中性粒细胞核左移，成熟红细胞缗钱样排列。骨髓细胞形态学有粒系在晚幼粒阶段成熟障碍；单核细胞、浆细胞和组织细胞增多等明显的异常。结论 HIV感染者的异常血液学改变，对于早期诊断HIV感染者，提供了一条有用的线索。