儿童不典型再生障碍性贫血与免疫性血小板减少性紫癜的特点及早期鉴别诊断

目的分析并比较不典型再生障碍性贫血(aplastic anemia，AA)和特发性血小板减少性紫癜(idiopathic chrombocytopenic purpura，ITP)的外周血及骨髓特点，为临床诊断提供一定依据，减少误诊的发生。方法选取2008年1月～2014年12月西安交通大学医学院第二附属医院收治的不典型再生障碍性贫血15例为不典型AA组；同期初诊的急性ITP 30例为ITP组。入院后均行血常规、骨髓涂片，自身抗体系列，抗血小板抗体等检查。所有病例入组前排除白血病，MDS，典型AA等血液疾病。结果不典型AA组患儿中性粒细胞计数为2.17±1.07(ANC)，血红蛋白为93.23±32.11 g/L(HB)显著低于ITP患儿(ANC为2.73±0.39 g/L及HB为111.11±42.23 g/L)，两组间进行t检验，差异具有统计学意义(P<0.05)；而ITP患儿血小板计数为(30.38±2.22)×109/L，显著低于不典型再障患儿(47.14±2.17)×109/L，两组间进行t检验，差异具有统计学意义(P<0.05)；不典型AA患儿巨核细胞数为17.83±7.83明显低于ITP患儿225.3±64.23，两组间进行t检验，差异具有统计学意义(P<0.05)。结论不典型AA和ITP存在许多相似性，容易发生误诊，当患儿出现血小板降低时，应仔细分析其他血细胞的特点，并参照骨髓穿刺结果，必要时进行骨髓活检以明确诊断。

Early Diagnosis of the Differention between Atypical Aplastic Anemia and Immune Thrombocytopenic Purpura in Children

ObjectiveTo compare peripheral blood and bone marrow features of in atypical aplastic anemia(AA) and ITP，provide the basis for clinical diagnosis and reduce misdiagnosis．Methods15 cases of atypical aplastic anemia (atypical AA group) and 30 cases of acute ITP (ITP group) were enrolled in our hospital，and compared two groups of children with peripheral hemogram，bone marrow smear and bone marrow biopsy features．Resultsatypical aplastic anemia group with neutrophil count (ANC) and hemoglobin (HB) was significantly lower than that of children with ITP (P<0.05)．While children with ITP compared children with atypical aplastic anemia have lower platelet count；atypical aplastic anemia in children with megakaryocyte number was significantly lower than that of children with ITP (P<0.05)．Bone marrow hyperplasia degree had significant difference comparison in two groups of children (P<0.05)．ConclusionAtypical aplastic anemia and ITP had many similarities and was easy to misdiagnose．When blood platelet decreasing in children，it should be carefully analyzing the features of other blood cells，at the same time should refer to the bone marrow biopsy results，necessary for bone marrow biopsy to confirm the diagnosis．