Rapid accurate absolute granulocyte count determination during severe leukopenia using the flow cytometer

The absolute granulocyte count (AGC) in 125 blood samples from patients with total white blood cell counts of less than 1,000/microliter was estimated using three different methods, which were then compared for efficiency and accuracy. The three methods were 25 cell differential counts using Wright's-stained blood smears, granulocyte percentage estimates from WBC counting chambers, and combined narrow- and wide-angle light-scatter characteristics determined on a flow cytometer. A survey of clinical laboratories at University Hospital Cancer Centers revealed that the smear differential was the most-often-used method in those laboratories even when less than 25 cells could be counted. Consequently the data obtained from the counting chamber and flow cytometer methods were compared to the smear differential "standard" using linear regression, and outliers were identified. There was good correlation between AGC determined by smear differential and WBC counting chamber (correlation coefficient .911) and excellent correlation between the AGC determined by smear differential and the flow cytometer method (correlation coefficient .970). The flow cytometer method used in this investigation required minimal specimen preparation, and test results were available at a rate of 60 seconds/sample. The ease of sample preparation, speed, and statistical reliability of test results makes the flow cytometer an attractive alternate method of determining granulocyte counts on leukopenic patients as compared to the stained blood smear differential.     

国内氯氮平引起白细胞减少和粒细胞缺乏文献回顾

目的 :了解常用抗精神病药氯氮平在我国应用引起白细胞减少和粒细胞缺乏的情况。方法 :依托北京 7家图书馆 ,对《中华 (神经 )精神科杂志》等 9种精神科杂志 ,《(中国 )新药与临床杂志》等 3种药学杂志逐年进行手工检索 ,收集国内自 1979年至 2 0 0 2年 11月公开发表的有关氯氮平引起白细胞减少和 或粒细胞缺乏的文献 10 7篇 ,其中个案报道 39篇 ,进行整理分析。结果 :白细胞减少发生率为 3 92 % (12 4 3 3174 9) ,粒细胞缺乏的发生率为 0 2 1% (92 4 330 2 )。收集到的 6 2例个案报道中 ,死亡 2 1例 (33 87% ) ,粒细胞缺乏发生者的平均年龄 (34 12± 12 39)岁 ,平均剂量 (318 33± 14 5 81)mg d。在 4 7例有发生距用药时间记录的病例中 ,4 2例发生在 90天内 (89 36 % ) ,2例的应用时间分别长达 5年半和 10年 ,由其余 4 5例得到的平均发生时间为 (4 6 4 7±2 6 4 0 )天。 6 2例中有 7例指明了与其他精神药物联用 ,4例死亡 (5 7 14 % )。结论 :应用氯氮平发生白细胞减少和粒细胞缺乏的风险较高 ,用药前 3个月是粒细胞缺乏的相对高发期 ,长期应用或联用其他精神药物仍有一定风险 ,建立定期的血象监测等措施十分必要     

电超导中药经皮外治药物性白细胞减少症162例疗效观察

目的:探讨电超导中药经皮外治药物性白细胞减少症的疗效。方法:将212例患者分为2组,治疗组162例,对照组50例。治疗组用中药外治法,对照组用口服西药升白细胞治疗,10天为1疗程。2组患者均在治疗后3、7、10天进行疗效观察。结果:治疗3、7、10天后,2组疗效比较,经统计学处理,差异有非常显著性意义(P<0.01)。结论:中药外治法可作为药物性白细胞减少症的一种治疗途径应用于临床。     

加味三才封髓汤治疗化疗后白细胞减少症

目的:观察加味三才封髓汤治疗化疗后白细胞减少症的临床疗效。方法:共纳入89例患者,随机分为治疗组、对照组:治疗组口服加味三才封髓汤,水煎服日1剂/d;对照组口服利血生20 mg/次,3次/d,鲨肝醇100 mg/次,3次/d。结果:治疗组升高白细胞的临床疗效、治疗后白细胞计数及体能状态改善均优于对照组,有显著统计学差异(P<0.01),并发感染及化疗延迟均低于对照组,有统计学差异(P<0.05),且治疗组未发现明显不良反应。结论:加味三才封髓汤不仅升高白细胞疗效确切,而且对患者体能状态恢复及机体免疫力的提高均有裨益,可以减少感染等并发症的出现,降低化疗延迟率,保证了肿瘤病人化疗计划的顺利完成。     

Determination of etiology in patients admitted due to isolated leukopenia

Patients with isolated leukopenia pose difficulties in diagnosis because there is no related guideline in the literature. In this study, our aim was to evaluate the clinical and laboratory associations of isolated, nonspecific (not related to neutropenia) leukopenia.In this retrospective data review study, patients who were admitted to Hacettepe University Hematology Outpatient Clinic between 2014 and 2019 due to leukopenia were evaluated. The patients with anemia (other than iron deficiency) or thrombocytopenia were excluded. Clinical and laboratory data and the final diagnoses (if present) of the remaining cases and especially of those without neutropenia (the most difficult group to diagnose) were evaluated.One hundred sixty-nine patients were included in the study. One hundred forty-four (85.2%) patients were female and 25 (14.8%) were male. One hundred ten of them had 1500/µL or higher neutrophil count. In these nonneutropenic cases, the etiological factors contributing to leukopenia were as follows: iron deficiency anemia (21.8%), other autoimmune/autoinflammatory diseases (17.3%), autoimmune thyroid disease (21.8%), autoimmune laboratory tests (2.7%), drugs (12.7%), infection (5.5%), hematopoietic disorder (2.7%), hypersplenism (2.7%), radiotherapy sequel (1.8%), and B₁₂ deficiency (1.8%). No etiology was recognized in 44 patients. On the other hand, the etiological factors in patients with neutrophil count <1500/µL were as follows; iron deficiency anemia (10.2%), other autoimmune/autoinflammatory diseases (17%), autoimmune thyroid disease (5.1%), autoimmune laboratory tests (8.5%), drugs (8.5%), infection (6.8%), hematopoietic disorder (11.9%), hypersplenism (1.7%), radiotherapy sequel (1.7%), and B₁₂ deficiency (1.7%). No etiology was recognized in 25 patients. Physicians ordered bone marrow examination more frequently in patients with neutropenia. If isolated antinuclear antibody positivity was also considered in favor of autoimmunity, 91/169 (53.8%) cases had an autoimmune diagnosis or laboratory finding.In the present study, the most frequent reasons of isolated leukopenia in nonneutropenic patients are found as iron deficiency anemia, other autoimmune/autoinflammatory diseases, and autoimmune thyroid disease. In neutropenic patients, the most frequent reasons of isolated leukopenia are found as iron deficiency anemia, autoimmune/autoinflammatory diseases, and hematopoietic disorders. Therefore, autoimmunity is detected as an important factor leading to isolated leukopenia.     

大剂量利血生片治疗白细胞减少症的有效性和安全性

目的评价大剂量利血生片治疗白细胞减少症的临床疗效和安全性。方法将70例抗甲亢药物引起的白细胞减少症患者随机分为3组：A组30例，口服大剂量利血生片40mg／次，每日3次；B组30例，口服常规剂量利血生片20mg／次，每日3次；C组（安慰剂组）10例，口服维生素B1片20mg／次，每日3次。疗程均为4周，观察治疗前后白细胞计数的变化和不良反应，并进行组间疗效对比。结果A组显效16例，有效10例，无效4例，总有效率为87％；B组显效9例，有效12例，无效9例，总有效率为70％。两组总有效率均明显高于安慰剂组（20％，P〈0．01），但A组优于B组（P〈0．05）。在治疗过程中未发现利血生片有任何毒副作用。结论大剂量利血生片治疗白细胞减少症，疗效优于常规剂量且安全。     

驴胶补血颗粒升高白细胞作用及机制研究进展

白细胞减少症是临床常见疾病,发病原因具有多样化,最常见为药物引起,且以抗肿瘤药物引起的白细胞减少症最为广泛。对于白细胞减少症的治疗,中药能够从多角度、多层面、多靶点发挥综合调控能力。驴胶补血颗粒作为补血益气中药,具有疗效好、使用方便,易被患者接受等特点,临床已有报道其在升高白细胞方面的应用。对驴胶补血颗粒全方、药对及单味药的升高白细胞的作用及机制进行综述,为扩大该药物的临床适应症及合理使用提供参考依据。     

瑞白治疗恶性肿瘤化疗所致的白细胞减少

目的:观察rhGCSF(瑞白)治疗恶性肿瘤化疗所致白细胞减少的疗效和不良反应。方法:用瑞白治疗32例恶性肿瘤化疗所致的白细胞减少症。白细胞计数(WBC)<3.9×109/L或中性粒细胞<2.5×109/L时开始用rhGCSF150μg皮下注射,每日一次,连用5d或以上,白细胞记数升至正常或以上时停药。结果:治疗后可使化疗后白细胞减少患者的白细胞恢复正常范围,平均6.5d,使化疗按期完成。结论:可有效的治疗化疗所致的白细胞减少症,明显缩短白细胞降至正常范围以下的持续时间,有利于化疗的顺利进行。     

白药子总生物碱对X射线辐射小鼠白细胞减少症的保护作用及机制研究

目的 探讨白药子总生物碱对 X 射线辐射损伤致小鼠白细胞减少的保护作用及其机制。方法 采用辐射法（一次性全身照射,照射剂量 2.5 Gy）制备白细胞减少症小鼠模型,90 只昆明种小鼠随机分为对照组,模型组,白药子生物碱低、中、高剂量（1.25、2.50、5.00 mg·kg^-1）组以及重组人粒细胞刺激因子（G-CSF）阳性对照组,共 6 组,每组 15 只。除对照组外,各组小鼠均进行 1 次性全身照射,白药子总生物碱各组分别于照射前 3 d 及照射后连续 ig 给药 3、15 d,G-CSF 组于照射前 3 d sc 给药,照射后 ig 给药 15 d。实验结束后取小鼠股骨计算有核细胞数及 DNA 水平。处死小鼠后称取小鼠肝脏、脾脏和胸腺质量,计算脏器指数。采用血液学分析仪分别于照射前及照射后 3、7、15 d 对外周血细胞中的白细胞（WBC）进行计数。收集小鼠血清,采用酶联免疫吸附法检测粒细胞-巨噬细胞集落刺激因子（GM-CSF）、血清 γ 干扰素（IFN-γ）、白细胞介素-3（IL-3）、白细胞介素-4（IL-4）、血管细胞黏附分子-1（VCAM-1）和可溶性细胞间黏附分子（SICAM-1）。通过苏木精和伊红染色检测小鼠肝脏、脾脏的病理变化。电镜观察脾脏、肝脏的超微结构。取肝脏组织,检测抗氧化相关指标。结果 白药子总生物碱可以明显抑制 X 射线照射后 14 d 内外周血白细胞的减少,同时提高 X 射线辐射后的骨髓 DNA 水平及小鼠造血生长因子 GM-CSF 水平,提高 X 射线辐射后免疫炎症因子 IL-3、SICAM-1 水平,减轻肝脏和脾脏组织损伤,维持小鼠肝脏、脾脏正常功能,并显著降低肝脏中的丙二醛（MDA）和黄嘌呤氧化酶（XOD）水平。结论 白药子总生物碱增强免疫和造血功能,揭示其作为放射防护剂和辐射缓解剂的治疗潜力。