再生障碍性贫血的幼红细胞超微病理

Ultrastructural characteristics of erythroid cell in aplastic anemia

目的:研究再生障碍性贫血患者(AA)幼红细胞病理特点。方法:透射电子显微镜观察和分析16例AA患者骨髓有核红细胞。结果:16例AA患者中,6例为急性再生障碍性贫血(SAA),10例为慢性再生障碍性贫血(CAA)。2例SAA和9例CAA幼红细胞形状不规则,见指状突起和切迹,部分细胞的细胞质空泡化。3例SAA和6例CAA的幼红细胞巨幼样改变明显,细胞核不规则。3例SAA和6例CAA幼红细胞核损伤显著,其中各2例有奶酪样核幼红细胞,共3例幼红细胞出现凋亡。3例CAA患者双核幼红细胞多见。5例SAA和5例CAA患者骨髓含大量单核/巨噬细胞激活和噬血细胞。结论:AA骨髓幼红细胞核与细胞质存在不同形式损伤,单核/巨噬细胞激活和吞噬活跃;红细胞自身发育障碍和单核吞噬激活损伤共同参与了AA病理过程。

Objective：To investigate pathological features of erythroid cell in bone marrow aspirate（BMA） from patients ＇with aplastic anemia, Method：Ultrastructural characteristics of erythroid cell in BMA from 16 patients with aplastic anemia were observed by transmission electron microscope. Result： 6 of 16 cases were diagnosed as severe aplastic anemia （SAA） and 10 as chronic aplastic anemia （CAA）. The erythroid cells showed finger like protrusion of cytoplasm and deep indentation of nuclei in 2 case of SAA and 9 of CAA, some erythroid ceils were vacuolated. Megaloblastics were found in 3 cases of SAA and 6 of CAA, most of them containing irregular nuclei. Injured nuclea：r features were exhibited in 3 cases of SAA and 6 of CAA, in which 4 cases had erythroid cells with Swiss cheese-like nuclear and 3 of them showed apoptotic erythroid cells. Binuclear erythroid cells were often found in 3/10 cases of CAA. On other hand, activated mononuclear macrophages and hemophagocytes were found in 5 cases of SAA and 5 of CAA. Conclusion, Erythroid cells from patients with AA exhibited varied injury features of nuclear or cytoplasm, some of them were phagocytized by activated mononuclear macrophage. Intrinsic defect of erythroid cell and phagoeytosis of mononuclear phagocyte participated in pathogenesis of AA.