三种血液病中淋巴样小巨核细胞及其病态巨核细胞的形态学观察

Morphological observations on microlymphomegakaryocyte and other pathological megakaryocyte in three type of hematologil diseases

目的:观察急性红白血病(AEL),骨髓异常增生综合征(MDS)及巨幼细胞性贫血(MA)骨髓象中淋巴样小巨核细胞及其他病态巨核细胞。方法:骨髓涂片,瑞特染色,低倍镜及油镜观察。对每例骨髓涂片进行巨核细胞(MK)计数,并做一系列组化染色,观察淋巴样小巨核细胞及其他病态巨核细胞的形态及阳性百分率。结果:MDS骨髓象中的淋巴样小巨核细胞、单圆核巨核细胞较AEL多见(P<0.05),与MA相比数量明显增多(P<0.01);MDS骨髓象中多圆核巨核细胞较AEL及MA增多(P<0.05);MA骨髓象中多分叶核巨核细胞检出率最高(P<0.01);MDS及AEL骨髓象中多圆核巨核细胞多<15μm,核形多规则,圆形且大小一致;MA骨髓象中,多圆核巨核细胞多>15μm,且核形以不规则和大小不一致居多。所有病例巨核细胞PAS染色,均为不同程度的阳性反应。结论:病态巨核细胞尤其是淋巴样小巨核细胞的出现对MDS和AEL等其他恶性血液系统疾病的鉴别诊断有着重要的价值。

Objective： To investigate microlymphomegakaryocytes and other pathological megakaryocytes （MKs） in acute erythroleukemia （AEL）, myelodysplastic syndrome （MDS） and megaloblastic anemia（MA）. Methods：We took bone marrow slides, and Wright-Giemsa stain, counted the number of MKs, made a series of histochemical staining, and observed the morphous and positive rate of microlymphomegakaryocytes and other pathological MKs through low power lens and immersion objective. Results： Microlymphomegakaryocytes and cyclomonomegakaryocytes in MDS were more than those observed in AEL （P〈0.05）, and significantly more than those in the MA（P〈0.01） . The multicyclomegakaryocytes observed in MDS were much more than that in AEL and MA. In addition, the detection rate of multifoliomegakaryocyte reached the highest value in MA（P〈0.01）. It was found that in MDS and AEL, most nucleus of the cyclomultimegakaryocytes were regular shape with uniform diameters （d〈15 μm）. Moreover, in MA, most nucleus of cyclomultimegakaryocytes were irregular shape with a wide size distribution of diameters （d〉15 μm） . The PAS staining tests for MKs were positive to various certain extends in all cases mentioned above. Conclusion： The presence of pathological MKs, especially microlymphomegakaryocytes in bone marrow played an important role in the differential diagnose of MDS, AEL and other malignant diseases of hematological system.