急性早幼粒细胞白血病伴噬血细胞增多的临床意义

Clinical significance of acute promyelocytic leukemia with hemophagocytic hyperplasia

目的 :探讨急性白血病 ( AL)和贫血患者噬血细胞 ( Hem)变化 ,以阐明 Hem在部分早幼粒细胞白血病( M3)出现的临床意义。方法 :观察 2 2 3例骨髓 Hem ,其中 5 1例 M3,72例其它 AL及 10 0例贫血患者。结果 :M3患者 Hem阳性 12例 ( 2 3.5 % )较其它 AL组 ( 4.2 % )和贫血组 ( 5 .0 % )明显增多 (均为 P <0 .0 1)。 M3患者的平均每片 Hem数为 2 9.4只 ,也明显多于其它 AL组 ( 2 .8只 )和贫血组 ( 2 .3只 )。随机选取 2 0例化疗后的 M3患者 ,其中 6例阳性患者化疗后的骨髓仍有 3例 Hem明显增高 ,3例已明显减少 ,而 14例阴性患者未见 Hem变化。结论 :M3伴 Hem增多作为部份 M3患者的一种特殊细胞学变化 ,对 M3的鉴别诊断及

Objective:To investigate the change of Hemophagocyte (Hem) in patients with acute leukemia and anemia ,and to explore its clinical significance in acute promyelocytic leukemia(M 3).Methods:To observe Hem in bone marrow smear of various kinds of leukemia and anemia ,including M 3 51,another AL 72 and anemia 100 .Results:The Hem was positive in 12 cases out of 51 cases ( 23.5 %)in M 3 group ,but another leukemia group only had 3 cases positive ( 4.2 %) and anemia group only had 5 cases ( 5.0 %). The positive rate of Hem in M 3 was higher than the other two groups respectively(P< 0.01 ).The average number of Hem in each smear in M 3 was 29.4 ,which was also obviously higher than the other two groups (AL group 2.8 and Anemia group 2.3 ).Observing a random selection of 20 patients after chemotherapy the Hem was still increase in 3 cases and another 3 cases had decrease ;while the Hem in negative cases did not change . Conclusion: M 3 with Hem hyporplasia may be a specific cytological variation in some patients ,which has valuable clinical significance in making a differential diagnosis of M 3 and studying the pathogenesis its liabrlity to produce pancytopenia and disseminated intravascular coagulation (DIC).