再生障碍性贫血的骨髓和细胞病理

The pathological characteristics of bone marrow and nucleated cells in aplastic anemia

目的:研究再生障碍性贫血(AA)患者骨髓组织病理及有核细胞的超微结构变化。方法:光镜观察20例AA患者骨髓活检病理,透射电镜分析骨髓有核细胞超微结构。结果:光镜下所有患者骨髓脂肪组织增多,造血面积减小,大部分存在血浆渗出、出血和纤维细胞局灶性增生,血窦血管结构紊乱。电镜观察显示原始和早幼红细胞代偿性不典型增生,中晚幼红细胞核损伤。粒细胞呈活化和损伤状态;巨核细胞显著减少,胞浆灶性坏死;单核细胞异常增生、活化、吞噬和坏死。淋巴细胞大部分结构正常。结论:AA患者骨髓造血细胞减少和炎症反应同时存在,单核巨噬细胞活化和吞噬反应与造血细胞损伤相关。

Objective： To investigate pathological features of bone marrow and ultrastructrual characteristics of nucleated cells in bone marrow from patient with plastic anemia （AA）. Method： Bone marrow biopsies of 20 patients with AA were stained HE method and observed by light microscopy, while nucleated cells isolated from bone marrow aspirate were observed by electron microscopy. Result： By light microscopy, all 20 patients showed increased adipose and decreased hematopoietic tissue, and most of them complicated with inflammation including exudation, haemorrhage, focal fibroblast proliferation, as well as collapsing of sinusoid and capillary architecture. Ultrastructrually, most of patients exhibited atypical compensatory hyperplasia of proerythroblasts and basophilic erythroblasts, but polychromatic and orthochromatic erythroblasts illustrated nuclear injury. Granulocytes showed reactive and damaged structure. Megakaryocyte showed focal cytoplasm necroses. Mononuclear /macrophages shared abnormal proliferation, activation, erythrocytophagys and necrosis. Most lymphocytes showed normal structure in most patients. Conclusion： Decrease of haematopoiesis area and intensive inflammation coexisted in bone marrow of patients with AA. Mean while, reactivity and phagocytosis of mononuclear/macrophages were closely related with nucleated cell injury in bone marrow.