骨髓增生异常综合征与巨幼红细胞性贫血的形态学鉴别诊断

目的通过对骨髓增生异常综合征（MDS）与巨幼红细胞性贫血（MA）血象、骨髓象的形态学分析，以提高对MDS与MA诊断及鉴别诊断的能力和水平。方法对51例MDS和43例MA患者血象及骨髓象形态学改变的资料进行细致分析。结果MDS以红系奇数核和巨大红细胞、淋巴样小巨核最有诊断意义；MA骨髓细胞呈“核幼质老”改变以红系为明显，粒系中幼粒以下各阶段细胞巨幼样变。结论奇数核细胞、淋巴样小巨核是MDS的主要特征；MA骨髓细胞呈“核幼质老”并以红系为明显，必要时可行其他辅助实验室检查，提高MDS和MA鉴别诊断水平。

Morphologic diagnosis and distinguished diagnosis between MDS and MA

Objective To study morphology of terminal blood and bone marrow in patients with MDS or MA, to advance the ability and the level of diagnosis and distinguished diagnosis between MDS or MA. Methods Careful analysis to morphologic information about blood picture and bone marrow picture of 51 cases with MDS and 43 cases with MA. Results Odd nuclear cells and large RBCs in erythrocyte system as well as little megakaryocytes shaped lymphocyte are the most diagnostic significance about MDS. While the changes of immature nuclear and aging plasma in bone marrow cells are obvious in erythrocyte system , every cells under the stage of myelocyte show megaloblastic transformation in leucocyte system. Conclusion Odd nuclear cells and little megalcaryocytes shaped lymphocyte are main specificity in patients with MDS, immature nuclear and aging plasma in bone marrow cells of erythrocyte system are obvious sign in patients with MA. The other helpful laboratory examines should be operated for the diagnosis and distinguished diagnosis between MDS or MA.