2例急性放射病患者造血干细胞移植前后骨髓象动态观察

The changes of bone marrow morphology in two patients with acute radiation sickness pre-and post hacmatopietic stem cell transplantation

目的研究肠型和极重度骨髓型放射病患者外周造血干细胞移植前后骨髓象的动态变化。方法分别对两例患者的骨髓标本进行常规瑞氏染色,每份样本在显微镜下计数200个有核细胞,分析骨髓各系统各阶段细胞数量和形态学改变。结果病例A(肠型放射病)较病例B(极重度骨髓型放射病)在受照后的骨髓损伤更严重。病例A于半相合移植后+7d,骨髓涂片只找到15个有核细胞,但可见中幼粒细胞,移植+14d后骨髓粒系、红系、巨核系均恢复造血功能,但未见产板巨核细胞。病例B于全相合移植后+7d,骨髓粒、红两系恢复,移植后+14d骨髓三系均恢复,各阶段细胞比值大致在正常范围。结论两例急性放射病患者在受照后骨髓损伤严重,但经半相合和全相合的外周血造血干细胞移植后,均在移植后2周骨髓恢复造血。

Objective The aim was to investigate the changes of bone marrow morphology of the two acute radiation symdrome （ARS） patients （A and B）. Methods The bone marrow smears of two patients was performed with Wright＇ s staining. At least 200 nucleated cells were counted under the microscope to analyse population and morphology of cells in each slide and stage of bone marrow. Results After radiation, the bone marrow injuries of patient A （intestine type） were worse than that of patient B （very severe degree of bone marrow type）. Patient A had only 15 karayocytes in bone marrow smear and myeloeytes on the 7th day after HLA-haploidentieal allogeneie peripheral blood stem cell transplantation （PBSCT）. Hematopoiesis of granulocytie,erythrocyte and megakaryoeyte series had generally recovered on the 14th day,except for the deficiency of platelet-forming megakaryocyte. Patient B was performed HLA-identical allogeneic PBSCT,Whose granulocytic and erythrocyte series recovered on the 7th day after transplantation, and Hematopoesis of three series almost recovered to normal on the 14th day. Conclusions The two ARS patients have their bone marrow injured seriously after irradiation, but both recovered their haematopoiesis of the bone marrow on the 14th day after PBSCT.