全血细胞减少症 106 例骨髓检查及病因分析

目的探讨骨髓检查对全血细胞减少症病因诊断的作用。方法对106例全血细胞减少症患者骨髓检查及诊断资料进行回顾分析。结果首次骨髓涂片检查确诊80例(75.5%),"血稀"18例、"干抽"6例,需重抽或行骨髓活检得以确诊。106例全血细胞减少症中由造血系统疾病引起的84例(79.2%),以再生障碍性贫血最常见,非造血系统疾病22例(20.8%)。结论骨髓检查是全血细胞减少症病因诊断的主要手段,部分非造血系统疾病的诊断需结合临床。     

71例全血细胞减少症的病因分析

目的：探讨全血细胞减少症（PCP）患者的病因,提高临床诊断准确率,为患者积极治疗提供帮助。方法：回顾性分析了2004年1月—2009年12月咸宁市第一人民医院就诊71例PCP患者的临床资料、外周血形态、骨髓细胞学检查及其他实验室检查结果,总结引起PCP常见的病因。结果：引起PCP病因较多,其中,造血系统疾病56例占78.9%,其中造血系统难治性恶性疾病33例占46.5%,包括AA占16.9%、MDS占12.7%、AL占9.9%、MM占2.8%、HL占2.8%、MF占1.4%;造血系统良性疾病23例占32.4%,包括MegA占19.9%、HPS占9.9%、IDA占2.8%;非造血系统疾病15例占21.1%,包括药物不良反应占9.9%、肝硬化占4.2%、脾功能亢进占4.2%、感染相关性疾病占2.8%。结论：对于全血减少的疾病患者,诊断时一定要紧密联系病史、体征、辅助检查等,先考虑造血系统难治性恶性疾病,再考虑造血系统良性疾病,然后考虑非造血系统疾病,做出正确诊断,力求避免误诊。     

55例老年人全血细胞减少骨髓象及病因分析

为了探讨老年人全血细胞减少的骨髓象特点和病因,做到早诊断、早治疗。现将我院近2年来收治的55例老年人全血细胞减少患者的骨髓象进行回顾性分析,报道如下。     

骨髓涂片及组织活检对比在全血细胞减少中的临床意义(附87例分析)

目的探讨骨髓涂片与组织活检对比在全血细胞减少中的临床意义。方法选常规骨髓穿刺部位,用骨髓活检针抽吸骨髓液涂片后同时取骨髓组织活检;对比分析87例全血细胞减少患者骨髓涂片与组织活检的结果。结果全血细胞减少患者骨髓涂片及活检对比提示,骨髓增生活跃及明显活跃组,多数可通过骨髓涂片,.辅以相关检查作出诊断。骨髓涂片显示增生重度低下组与活检结果差异不大;但骨髓涂片显示增生低下的41例病人中,则与骨髓活检结果(26例显示增生低下)差异较大。这41例骨髓涂片增生低下的病人同步行骨髓活检,显示以慢性再生障碍性贫血(CAA),骨髓增生异常综合征(MDS)及早期低增生性白血病多见。结论骨髓涂片同步或同期行骨髓组织活检对比,对于全血细胞减少中低增生性白血病,MDS、CAA具有鉴别诊断意义。     

全血细胞减少83例病因分析

目的 分析临床常见的全血细胞减少的原因，降低诊断此类疾病的误诊率。方法 对83例初诊全血细胞减少患者临床资料进行回顾性分析。结果 由造血系统疾病引起的全血细胞减少62例，占74．6％；非造血系统疾病21例，占25.4％。结论 造血系统疾病是全血细胞减少的主要原因，但非造血系统疾病也应予以充分重视。     

全血细胞减少134例病因学分析

全血细胞减少。山h造血系统疾病或非造血系统疾病引起。造血系统引起的全血细胞减少常见于再生障碍性贫血（AA）叫h（血性白血病”、骨髓增生异常综合征、恶性组织细胞增生症（恶组）、骨髓纤维他、牌功能亢进症,也见于淋巴瘤、多发性骨髓瘤、阵发性睡眠性血红蛋H尿（PNH）、血栓性血小板减少性紫任等,确诊有时不易．初期极易误诊。现将我院8年收集的134例全血细胞减少病例分析如下：1临床资料134例中,男78例,女56例,年龄15～75岁。最初诊断为AA者35例,其中误诊10例;最初诊断为白血病25例,8例误诊;最初诊断为脾功能力进20例,6…     

全血细胞减少207例骨髓象及病因分析

1994年1月至2004年1月，我院收治207例全细胞减少患者。现对其骨髓象及病因分析如下。     

全血细胞减少症的鉴别诊断

众所周知，全血细胞减少症不是一个独立疾病，它是一组高度异质性疾病在某一侧面的共同表现。按病理生理的不同，全血细胞减少症可分为骨髓生成障碍(包括骨髓增生减低及骨髓无效造血)及外周消耗过多两大类。骨髓生成障碍可进一步分为非克隆增殖性疾病及克隆增殖性疾病，而后者又可分为良性克隆增殖及恶性克隆增殖性疾病。     

全血细胞减少528例分析

全血细胞减少由造血系统疾病引起已被临床医生所熟知 ,但某些非造血系统疾病也可引起全血细胞减少尚未引起临床重视 ,故易引起漏诊及误诊。现将我院近 1 0年来收治的 52 8例全血细胞减少患者的病因作一分析 ,以提高诊断的准确率。1　临床资料本组患者 52 8例 ,男 2 96例 ,女 2 32例 ,年龄 1 5～ 82岁。全部患者均符合下述诊断标准。多次血常规检查至少有 2次血红蛋白 <1 0 0 g/L,白细胞 <4× 1 0 9/L,血小板 <1 0 0× 1 0 9/L。2 　 结果再生障碍性贫血 1 92例 ( 36.4% ) ,骨髓检查增生减低 ,三系造血细胞减少 ,非造血细胞增多 ,并经多部…     

骨髓细胞学检查在全血细胞减少症中的检验研究

目的:探究将骨髓细胞形态学检查运用在全血细胞减少症患者中进行诊断的效果.方法:随机将2019年3月至2020年2月期间本院全血细胞减少症患者88例,均开展骨髓细胞形态学检查.结果:全血细胞减少症88例患者中再生障碍性的贫血有37例(42.05％),16例为骨髓增生的异常综合征(18.18％),10例增生性贫血(11.3...     

Comparative Evaluation of Simultaneous Bone Marrow Aspiration and Bone Marrow Biopsy: An Institutional Experience

Bone marrow aspirations and bone marrow biopsies are important diagnostic procedures. A comparative study of both the procedures done simultaneously was retrospectively reviewed in 160 cases where the clinical history is correlated with BMA and BMB results. The advantage of each method is analyzed. Correlation of our findings with that given in the literature is done to give a guideline for both techniques. We have found that 61.25% of the cases showed a positive correlation between bone marrow aspiration and bone marrow biopsy. However, we found that tuberculous granulomas and Hodgkin disease involvement of the marrow were detected better in bone marrow biopsies. The advantage of both the procedures done together provided more material and enabled us to study the cytomorphology of the cells, with the pattern of distribution of the cells depending on the cases. However, when both the procedures are done simultaneously, a proper technique is required so as to yield good diagnostic material.     

Re-evaluation of Need for Bone Marrow Examination in Patients with Isolated Thrombocytopenia Contributors

Diagnosis of immune thrombocytopenia (ITP) is based on clinical suspicion and normal peripheral smear except for thrombocytopenia. Bone marrow examination is carried out to rule out leukemia, myelodysplastic syndrome or aplastic anemia. However, in most cases, clinical diagnosis is not altered after the bone marrow reports. Hence, this present study was carried out to evaluate the justification for bone marrow examination in the setting of isolated thrombocytopenia. All patients presenting to the hematology OPD with isolated thrombocytopenia and suspected diagnosis of ITP, between October 2011 and April 2013, were included in the study. Data was collected from bone marrow reports and outpatient records. A total of 353 cases were found. 319 cases had features of typical ITP and the rest had some form of organomegaly and/or lymphadenopathy. Bone marrow examination in all cases revealed normal hematopoietic elements and prominence of megakaryocytes including juvenile forms with no novel diagnosis in any patient. Routine use of bone marrow examination in the diagnostic workup of isolated thrombocytopenia is not required in our center even if steroids are planned as a first line therapy. However, a detailed history, thorough examination with complete hemogram and peripheral smear examination are essential.     

骨髓检查在临床诊断中的价值：附722例分析

目的 :探讨骨髓像对临床 ,尤其是血液病诊断的意义。方法 :结合 72 2例骨髓穿刺检查结果进行回顾性分析 ,其中 2 10例进行了骨髓活检。结果 :对各类型白血病、多发性骨髓瘤、骨髓转移癌、部分恶性组织细胞病及疟疾可确诊。可协助增生性贫血、再障等疾病的诊断及与某些疾病的鉴别诊断。结论 :骨髓检查、周围血检查及临床资料对诊断血液系统疾病、感染性疾病是重要的     

Comparison of Bone Marrow Involvement with Bone Marrow Biopsy and PET–CT and Evaluation of Any Effects on Survival in Patients Diagnosed with Hodgkin and Non-Hodgkin Lymphoma

We aimed to demonstrate whether PET–CT can replace bone marrow biopsy in detecting bone marrow involvement in subtypes of lymphoma. In addition, we aimed to also reveal whether there is a difference between the mean survival of patients with bone marrow involvement via PET–CT or biopsy. A total of 276 newly diagnosed lymphoma patients who underwent bone marrow biopsy and PET–CT prior to the treatment were scanned retrospectively. Bone marrow biopsy was used as the standard method to investigate the presence of bone marrow involvement in PET–CT. The relationship between bone marrow involvement and mean survival was compared using both methods. Out of the 276 patients, bone marrow involvement was detected with PET–CT and with biopsy, respectively in 56 patients (20.2%) and in 78 patients (28.2%). In terms of PET–CT’s accuracy with respect to revealing bone marrow involvement, the highest rates were achieved respectively in diffuse large B cell lymphoma (DLBCL) (87.4%) and Hodgkin lymphoma (HL) (77.7%). In both the PET–CT and bone marrow biopsy methods, Overall Survival (OS) was found to be significantly shorter in patients with involvement than in patients without involvement (P: 0.001). PET–CT may replace bone marrow (BM) biopsy in detecting the bone marrow involvement in aggressive lymphoma subtypes such as DLBCL and HL. The presence of BM involvement at the time of diagnosis in both PET–CT and BM biopsy is associated with poor prognosis, and OS is short in this group.     

47例骨髓穿刺干抽的临床及病理分析

作者分析该院发生的47例骨髓穿刺干抽的临床及病理改变,47例干抽占同期1319例骨髓穿刺的3.6％。根据骨髓细胞的密度和间质纤维增殖的程度,把干抽的原因分为4类:高细胞伴间质细胞增多19例(42.2％);间质细胞增多14例(1.1％);高细胞8例(17.8％)及低细胞4例(8.9％)。主要疾病为:急性淋巴细胞白血病(25.5％),急性非淋巴细胞白血病(17.0％),慢性白血病(14.9％),骨髓转移癌(10.6％),再障(6.4％),原发性骨髓纤维化(6.4％)。27例白血病占47例干抽的57.4％,其干抽原因与间质细胞增多和(或)高细胞性有关;骨髓转移癌的干抽与继发骨髓纤维化有关;再障的干抽与骨髓细胞显著减少有关。     

骨髓活检对急性白血病的治疗方案制定及预后评估

比较了５３例治疗前急性白血病骨髓穿刺涂片及民埋骨髓活检切片标本，发现其骨髓增生程度判断结果差异明显，真正的低增生型及伴骨髓纤维化的急性白血病并不多见。原始细胞非均一性浸润的白血病患者，对常规化疗效果差，可能需要特殊的改良方案。     

Therapeutic Plasma Exchange in Patients Suffering from Thrombotic Microangiopathy after Allogeneic Bone Marrow Transplantation

Thrombotic microangiopathy (TM) is a potentially fatal complication of allogeneic bone marrow transplantation (BMT). The underlying pathophysiology is thought to be generalized endothelial cell damage caused by several factors including conditioning treatment, cyclosporin A (CsA,) or graft versus host disease (GVHD). In the present retrospective study, 6 patients suffering from Grade 2 BMT-TM at a mean of 62 days post BMT were treated by 3–15 daily sessions of therapeutic plasma exchange (TPE). In most sessions, cryosupernatant (CSN) of plasma, in some fresh frozen plasma (FFP) was used as the substitution fluid. All patients suffered from acute graft versus host disease (aGVHD) of the skin, which was treated by CsA. CsA was withdrawn in all patients. TPE caused a response in 4 of 6 patients evidenced by a decrease to Grade 0 (n = 3) or 1 (n = 1) BMT-TM. Only 1 patient had mild renal insufficiency which did not improve during TPE. While all patients were dependent on platelet transfusions at baseline, the platelet counts improved in 2 of 6 patients after the TPE course. One patient did not show any response to TPE with FFP, and his disease improved only after CSN was introduced as substitution fluid (Grade 0). Four patients were still alive 175–495 days post BMT, and 2 patients died about 2–3 weeks after the end of the TPE course, 1 from cachexia and 1 from systemic aspergillosis. In summary, in this pilot study, TPE positively influenced BMT-TM, especially if CSN was used as the substitution fluid.     

喀什地区内脏利什曼病患者血常规及骨髓象变化的分析

统计分析125例内脏利什曼病患者血细胞7项参数及骨髓检查结果,发现多数患者血细胞7项参数均显著低于参考范围;骨髓检查结果显示,感染骨髓象伴缺铁性贫血（IDA）及细胞成熟障碍者占64.8%。统计结果表明,内脏利什曼病患者多表现为较严重的感染和缺铁性贫血以及血细胞参数显著降低,这可作为反映内脏利什曼病严重程度的重要指标。     

52例白血病骨髓活组织检查的观察

采用塑料包埋薄切片技术对52例白血病骨髓活组织进行病理检查结果显示:32例急性白血病中24例伴有不同程度纤维细胞增加或纤维化,其程度越重预后越差。20例慢性粒细胞白血病全部伴有纤维细胞增加或不同程度纤维化,程度越严重脾脏越大。同时本文对化疗前后基质损伤程度与预后关系等问题进行了讨论。     

Serum KL-6 Levels in Patients With Pulmonary Complications After Allogeneic Bone Marrow Transplantation

KL-6, a mucinous high—molecular weight glycoprotein expressed on type 2 pneumocytes, has been shown to be elevated in the serum and bronchoalveolar lavage fluid of patients with interstitial pneumonitis (IP). We measured the serum levels of KL-6 in patients after they had undergone allogeneic bone marrow transplantation (BMT) to determine whether KL-6 could be a clinically useful indicator for the development of IP. The serum concentrations of KL-6 were determined by a sandwichtype enzyme-linked immunosorbent assay using an anti—KL-6 monoclonal antibody. A total of 1028 samples were tested from 76 patients (78 transplantations) who received BMTs. The KL-6 values were markedly elevated in patients with pulmonary complications, but not in those with acute and chronic graft-versus-host disease, hemorrhagic cystitis, herpes encephalitis, sepsis, and veno-occlusive disease.The serum levels of KL-6 from patients with pulmonary complications were significantly higher than from those without pulmonary complications (P < .001) and those with other complications (P < .001). Of the 12 patients with pulmonary complications, 6 had idiopathic IP (IIP). The levels were not high at the onset of IIP. Four of 6 IIP patients showed marked elevations of KL-6 levels in parallel with the severity of IP and died of respiratory failure without response to treatment.Assessment of serum KL-6 levels might not be useful for the early diagnosis of IP, but may be a useful indicator for monitoring the severity of IP after BMT.