肺癌合并类白血病反应1例骨髓诊断分析

类白血病反应（尤其是粒细胞型类白血病反应）易与慢性中性粒细胞白血病相混淆。类白血病反应有明确的病因,有原发疾病的临床表现,常为严重感染及恶性肿瘤,一般多伴有严重的临床表现。慢性中性粒细胞白血病无类白血病反应之明确病因,所有病例均有脾肿大,而且患者组织病理学镜下检查常见中性成熟粒细胞的弥漫性或灶性浸润。本文对1例肺癌合并类白血病的骨髓诊断进行分析,报道如下。     

巨核细胞在慢性粒细胞白血病与类白血病反应鉴别诊断中的意义

慢性粒细胞白血病（CML）与类白血病反应（简称类白）有时会遇到鉴别诊断困难，笔在阅片中发现骨髓巨核细胞在这两病中常有着明显的差别，现将观察结果报道如下。     

儿童急性早幼粒细胞白血病研究进展

急性早幼粒细胞白血病是以骨髓中异常早幼粒细胞增多为特征的急性髓系白血病,目前被认为是可治愈的急性白血病,常见于20岁以上的患者。儿童急性早幼粒细胞白血病的临床特征、预后、治疗及治疗后的并发症与成人相比有一些不同之处,现将儿童急性早幼粒细胞白血病的研究现状及治疗进展进行综述。     

恶性肿瘤合并类白血病反应46例临床报告并肿瘤分期探讨

近年来,恶性肿瘤的发病率呈逐年增高的趋势,治愈率低、病死率高。而且,在肿瘤细胞的持续作用下或转移过程中,患者容易出现血液学的改变,形成贫血、血栓、血小板异常以及类白血病反应等。类白血病反应（LR）是指机体在没有明显的骨髓病变的情况下,发生的外周血白细胞计数超过20×109/L和（或）存在有异常未成熟白细胞的症状。产生类白血病反应的原因有很多,例如严重感染、溶血、出血、药物过敏或者恶性肿等，且以复发或进展性的恶性肿瘤居多。但并未检索到具体研究其发病情况与肿瘤分期及部位关系的相关文献。现就本院曾经收治的肿瘤病例进行回顾性分析，以期能够在小样本的情况下分析恶性肿瘤合并类白血病反应的治疗方法并估计其发病情况与肿瘤分期和发病部位的关系。     

类早幼粒细胞白血病反应的急性粒细胞缺乏症：附5例分析

本文报告5例易与早幼粒细胞白血病混淆的类早幼粒细胞白血病反应的粒细胞缺乏症（简称粒缺）。这一粒缺血象的临床表现与一般粒缺相同，但骨髓象突出异常为早幼粒增多，甚至高达30％以上，NEC高达50％以上，后期粒细胞很少，甚至消失。增多的早幼粒胞体增大，颗粒多而较粗大，但不密集，不见细颗粒，缺乏瘤状突起和异形性改变。     

新生儿类白血病反应：附2例报告

新生儿类白血病反应（附２例报告）江苏省苏州市妇幼保健院（２１５００３）施璇华类白血病反应在小儿时期可由感染、中毒、肿瘤及严重出血等病因引起［１］，但新生儿较少，淋巴细胞性类白血病反应更罕见［２］。现报道新生儿表皮葡萄球菌感染引起淋巴细胞性类白血病反应...     

三氧化二砷治疗复发性急性早幼粒细胞白血病的观察与护理

目的 为了探讨三氧化二砷治疗复发性早幼粒细胞白血病的疗效与护理。方法 对9例复发的急性早幼粒细胞白血病患者应用三氧化二砷治疗及辅以良好的护理观察其完全缓解率。结果 9例中完全缓解6例，占66．7％，部分缓解1例，总有效率77．8％。结论 三氧化二砷治疗复发的急性早幼粒细胞白血病，其完全缓解率高，且与维甲酸与化疗药物之间无交叉耐药，副作用小。     

类白血病反应误诊为白血病8例分析

类白血病反应误诊为白血病８例分析江苏省扬州市人民医院［２２５００１］刘正衡类白血病反应是继发于某种疾病的一种综合征，常易误诊为白血病，不少病例因此由基层匆忙转诊。现将我院所见８例分析如下，以提高诊断水平。临床资料本组中男性３例，女性５例，年龄２２～６...     

恶性肿瘤出现类白血病反应23例临床报告

目的:探讨恶性肿瘤合并类白血病反应的特点及临床意义.方法:对我院2003年5月～2007年 2月收治的恶性肿瘤合并类白血病反应的23例临床资料进行回顾性分析. 结果:合并骨转移7例(30.43%),合并骨髓浸润5例(21.74%),恶性肿瘤晚期广泛转移11例(47.83%).结论:恶性肿瘤易发生类白血病反应,应注意有骨转移、骨髓浸润和(或)病情进展的可能.     

结肠癌致类白血病反应误诊为骨髓增生异常综合征

炎症、感染、组织损伤、肿瘤浸润等病理状态均可刺激骨髓引起中性粒细胞增多。当外周血白细胞计数高于25.0×109/L,以成熟的中性粒细胞为主,同时出现中幼粒细胞和晚幼粒细胞时,即称中性粒细胞类白血病反应。我院近年收治1例以类白血病反应为主要临床表现的结肠癌,曾被误诊为骨髓增生异常综合征。现报道如下。     

Kinetic studies of a tumor-induced leukemoid reaction in mice.

A transplantable murine breast carcinoma in mice was associated with marked leukemoid reaction. Within 1 week of subcutaneous implantation of tumor the leukocyte count began to increase and reached average levels of 165,000 leukocytes per cubic millimeter within 18 days. This represented an increase in mature neutrophils primarily, although other blood leukocytes were modestly increased as well. The total number of neutrophils per humerus was increased but no increase was detected in the number of myloblasts, promyelocytes, or myelocytes. The tritiated thymidine-labeling index of the latter three cells was not significantly changed during tumor growth. The number of progenitor cells forming granulocytic and mononuclear cells in vitro was decreased in the marrow during tumor growth. Colony-stimulating activity in plasma was slightly increased during the early phase of tumor growth and decreased during later phases. Emergence time of blood neutrophils was normal, as measured by labeling with tritiated thymidine, but decline in labeled cells was abnormally slow in tumor-bearing mice. There was a shift of erythropoiesis to the spleen, but total erythropoiesis appeared to be normal in most mice. Surgical excision of the tumor resulted in prompt reversal of the leukemoid reaction. In the aggregate these results are consistent with a hypothesis that the leukemoid reaction was the result of increased blood transit time of neutrophils primarily, rather than increased neutrophil production.     

Hematological masks of malignant neoplasms of the internal organs

Hematological "masks" of malignant tumors of the internal organs are not infrequent in clinical practice. A total of 45 patients with malignant tumors of the internal organs (stomach-12, colon-9, liver-3, lungs-9, kidneys-6, pancreas-2, thyroid-2, bladder-1, prostate-1) were under observation. Hematological signs of bone marrow metastatic involvement were as follows: anemia (mainly hypochromic), leukemoid neutrophilic reaction, leukemoid reaction of myeloid type, erythrocytosis, thrombocytosis, plasmocyte bone marrow reaction. Early cancer diagnosis, especially in obscure peripheral blood changes, requires a complete all-round investigation of a patient including an analysis of clinico-anamnestic data, the use of radiographic and endoscopic methods, sternal puncture and trephine biopsy.     

Granulocyte progenitors (CFU-D) in neutrophilic leukemoid reaction are hyporesponsive to macrophage-induced inhibition

The responsiveness of marrow granulocyte progenitors (CFU-D) to macrophage-derived stimulatory and inhibitory factors has been studied using diffusion chamber technique in 12 patients with neutrophilic leukemoid reaction (with granulocyte count in the range between 10-40 G/l) and ten healthy subjects. CFU-D from patients with neutrophilic leukemoid reaction (NLR) revealed a normal reactivity to colony-stimulating activity, whereas they were hyporesponsive to macrophage-derived indomethacin-sensitive inhibition. This altered response was correlated both with the concentration of granulocyte progenitors in the S phase and with blood neutrophilic leukocytosis. In patients with higher granulocyte count and increased concentration of CFU-D during active DNA synthesis a more pronounced hyporesponsiveness of granulocyte progenitors to macrophage-induced inhibition has been found.     

Leukemoid reactions complicating colitis due to Clostridium difficile

BACKGROUND: We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 x 10(9)/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions. METHODS: We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 x 10(9)/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 x 10(9)/L). Results: The mean peak leukocyte count was 52 +/- 18.2 x 10(9)/L (+/- SD) in the case group and 14.9 +/- 6.5 x 10(9)/L in the control group. Patients with a leukemoid reaction had a lower temperature, a lower serum albumin level, and a higher hematocrit value. Multivariable logistic regression showed respiratory tract infection and lower temperature to be independent predictors of a leukemoid reaction. There were 10 deaths (50%) in the leukemoid reaction group and 5 deaths (7.7%) in the control group. All seven patients with a peak leukocyte count greater than 50 x 10(9)/L died, compared with eight deaths (10.3%) among the remaining 78 patients whose peak leukocyte count was less than 50 X 10(9)/L. CONCLUSION: Patients with C difficile colitis and a leukocyte count greater than 35 x 10(9)/L have a poor prognosis with a much higher mortality rate than patients who have C difficile colitis without a leukemoid reaction.     

High mortality among patients with the leukemoid reaction and alcoholic hepatitis

We describe a patient with severe alcoholic hepatitis, markedly elevated white blood cell count, and high fever. After review of the English literature, we discovered reports of other cases similar to our case. The striking feature in all of these cases was a high short-term mortality rate, despite predictions of a favorable outcome. We therefore believe these patients represent a subgroup of patients with alcoholic hepatitis and that the leukemoid reaction is a poor prognostic sign in this disease.     

A method for obtaining human bone marrow specimens enriched for myeloblasts and promyelocytes.

A simple method has been developed for obtaining specimens of human marrow which are enriched for myeloblasts and promyelocytes. The erythrocytes are lysed, the marrow is incubated with iron particles, and the cells that phagocytize the iron are removed with a powerful magnet. The marrow is then subjected to a density-cut centrifugation using Ficol-Hypaque with a density of 1.084 gm/mm3. The cells that do not enter the Ficol-Hypaque are removed from the surface and studied. The proportion of myeloblasts and promyelocytes in this subpopulation of cells exceeds 50%. Total recovery of these immature myeloid progenitor cells is 50% of that in the original marrow specimen. This method has been used for cell suspensions containing as many as 10(9) cells. Cells prepared using this method incorporate 3H-TdR, 3H-UR, and 3H-Leu at a higher rate than the unseparated specimens and have a cloning efficiency of 2.0% to 19.4% compared with 0.1% to 2.17% for the unseparated marrows.     

Probable myeloblastic leukemoid reaction with disseminated sarcoidosis.

A 55-year-old woman had progressive weakness, weight loss, night sweats, fever, right-sided facial weakness, and hepatomegaly. Reticulonodular infiltrates were seen on chest x-ray film and a central filling defect was noted on liver scan. Study of the peripheral blood was noted on liver scan. Study of the peripheral blood revealed pancytopenia and myeloblasts. The bone marrow was not markedly hypercellular but contained noncaseating granulomas and myeloblasts. The patient's condition deteriorated and she died on the 22nd hospital day. Autopsy disclosed disseminated sarcoidosis but no evidence of leukemic infiltrates. Although concomitant "smoldering" acute leukemia cannot be ruled out, the findings in this patient can be best explained on the basis of a myeloblastic leukemoid reaction accompanying sarcoidosis.     

Severe multisystemic hypersensitivity reaction to carbamazepine including dyserythropoietic anemia.

OBJECTIVE: To report a case of multisystemic hypersensitivity reaction to carbamazepine. CASE SUMMARY: An 81-year-old white man was admitted to our hospital because of fever, morbilliform pruritic rash, and jaundice. Fifty days before admission he had taken carbamazepine 200 mg p.o. tid because of seizures. During the first few days following admission, a maculopapular rash progressed to generalized erythroderma with subsequent extensive skin exfoliation. After discontinuing carbamazepine the fever disappeared within 72 hours and hepatic function tests returned to normal within four days. Moreover, after admission the hemoglobin values gradually fell to 6.7 g/100 mL. A bone marrow aspirate showed hypercellularity with marked dyserythropoietic abnormalities, and the bone marrow biopsy showed large and diffused infiltration due to the presence of a low-grade small lymphocytic lymphoma. No specific therapy for the lymphoma was undertaken. The biochemical follow-up showed a total improvement of hemoglobin values. Eight months after drug discontinuation, the patient was asymptomatic; peripheral blood cell count and hemoglobin concentrations were persistently normal. DISCUSSION: To the best of our knowledge, this is the first published case report implicating carbamazepine as the cause of anemia associated with bone marrow hypercellularity and dyserythropoietic changes, instead of hypocellularity and reduction of erythroid precursors. An interesting point raised by our observation is the possible relation between carbamazepine intake and actual lymphoproliferative disease. The development of non-Hodgkin's lymphoma following carbamazepine treatment has been reported, with regression after the drug was discontinued. However, in our case, a bone marrow biopsy repeated eight months after drug discontinuation confirmed the diagnosis of low-grade lymphoma. CONCLUSIONS: This case report describes a severe multisystemic reaction, characterized by generalized erythroderma; and renal, hepatic, and bone marrow failure in a patient who started carbamazepine therapy 50 days beforehand.     

恶性肿瘤类白血病反应的中毒性中性粒细胞的MAXM血液分析仪分析

目的探讨恶性肿瘤伴类白血病反应患者的中毒中性粒细胞是否被MAXM血细胞分析仪误认为嗜碱性粒细胞。方法MAXM血细胞分析仪进行白细胞计数和分类;瑞氏染色镜检白细胞分类;过氧化物酶染色区分中性粒细胞和嗜碱性粒细胞;碱性磷酸酶染色区分类白血病反应。结果26例恶性肿瘤患者用MAXM血细胞分析仪进行白细胞计数为:(28.6±5.7)×109/L;分类为:中性粒细胞49.9%±10.6%,淋巴细胞15.2%±4.3%,单核细胞2.2%±1.2%,嗜酸性粒细胞0.4%±0.3%,嗜碱性粒细胞32.3%±10.2%。镜检分类为:中性粒细胞85.6%±11.8%,淋巴细胞12.9%±5.1%,单核细胞1.5%±1.4%,嗜酸性粒细胞0%,嗜碱性粒细胞0%,其中中毒中性粒细胞为36.5%±7.6%。过氧化物酶染色阳性率为:89.6%±12.3%。中性粒细胞碱性磷酸酶阳性率为83.1%±12.5%,积分395±63。结论MAXM血细胞分析仪把类白血病中毒中性粒细胞误认为嗜碱性粒细胞。