以出血为起始的血细胞减少性疾病血小板及巨核细胞形态观察简

目的观察以出血为起始的血细胞减少性疾病外周血小板及骨髓巨核细胞形态特点，探讨其诊断价值。方法用瑞氏染色，对患者外周血涂片血小板及骨髓巨核细胞形态进行分析观察。结果（1）骨髓增生异常综合症（MDS）组主要以外周血椭圆形血小板和涂片尾部出现大小不均-血小板3-4个聚集现象为主，骨髓主要见于单圆核巨核细胞、小巨核细胞及多圆核巨核细胞。（2）急性白血病（AL）组仅表现外周血涂片尾部出现大小不均-血小板3～4个聚集现象。（3）慢性再生障碍性贫血（CAA）组外周血小板体积小为主要特征尤以骨髓巨核细胞≤3个／片。（4）巨幼细胞性贫血（MA）组则以外周血巨大血小板及骨髓体积增大巨核细胞和多分叶核巨核细胞为主要特征。（5）特发性血小板减少性紫癜（ITP）组外周血小板主要表现为大小不均一较明显，骨髓则以多分叶核巨核细胞检出率较高。结论以出血为起始的各类血细胞减少性疾病其外周血小板及骨髓巨核细胞均可见有病态细胞，尤以MDS组最为显著，提示病态血小板及巨核细胞在各类血细胞减少性疾病的鉴别诊断中具有重要意义。

Morpgology of Platelet and Megakaryocyte in Hemocytopenia Disease Starting with the Bleeding

Objective To observe the morpgology of platelet in peripheral blood and megakaryocytes in hemocytopenia disease starting with the bleeding, Explore the morphological evidence related to diagnosis. Methods With Wright＇ s stain, observe the morpgology of platelet in peripheral blood and megakaryocytes. Results （ 1 ） Group myelodysplastic syndrome （MDS） mainly shows that the oval plaque appeared in peripher- al blood and uneven size of platelets 3 - 4 aggregation appears in the tail of smear, while single nuclear megakaryocytes, micromegakaryocytes, multi-nuclear megakaryocytes mainly be found in bone marrow. （2） Group acute leukemia（AL） only showed uneven size of platelets 3 -4 aggregation appears in the tail of smear. （3） Group Chronic aplastic anemia （CAA）are characterized by small platelet of peripheral blood, especially the megakaryoeytes in the bone marrow ≤3/smear. （4）Group megaloblastic anemia（MA） are characterized by giant platelet in peripheral blood and megakaryocytes volume increase, multi-sublobe megakaryocytes in the bone marrow. （5） Group idiopathic thrombocytopenic purpura（ITP） shows that uneven size of platelets obvious in peripheral blood, and multi- sublobe megakaryocytes＇ detection rate is higher in the bone marrow. Conclu- sion All kinds of hemocytopenia disease starting with the bleeding can find the morbidness eell including the platelet of peripheral blood and the megakaryocytes of bone marrow, especially in the MDS group, Suggests that morbidness platelet and megakaryocytes play an important role in differential diagnosis of all kinds of hemoey- topenia disease starting with the bleeding.