肝移植患者围手术期骨髓细胞学改变的意义

Significance of bone marrow cytology during perioperative period of orthotopic liver transplantation

背景:晚期肝病及肝移植后造血系统受累相关报道较少见。目的:通过对肝移植患者围手术期骨髓细胞学的观察,探讨移植前造血功能的改变及移植后多种并发症对骨髓造血功能的影响。方法:选择20例实施原位肝移植患者,因与血液系统疾病相关,需行骨髓细胞学检查进行诊断及鉴别诊断,其中移植前2例,移植后18例。结果与结论:原位肝移植患者移植前容易出现骨髓细胞学改变为脾功能亢进、大红细胞性贫血,移植后出现:移植物抗宿主病、浆细胞白血病、反应性粒细胞增高、原发性血小板减少性紫癜、嗜血细胞综合征、粒细胞缺乏症、急性造血细胞停滞、转移癌、反应性血小板增高。说明通过骨髓细胞学检查,监测肝移植围手术期各种并发症对骨髓造血功的影响,特别对移植物抗宿主病的患者,实施及时抢救有重要意义。

BACKGROUND： The reports on the advanced liver disease and liver transplantation hematopoietic system which affected are rare. OBJECTIVE： To study the characteristics of hematopoiesis function before orthotopic liver transplantation and the effects of a series of post-operation complications on hematopoiesis function of the bone marrow after orthotopic liver transplantation by observing bone marrow cytology. METHODS： Bone marrow cytology was analyzed in 20 cases of orthotopic liver transplantation. Due to the relationship with hematological diseases, bone marrow cytology examination was needed to be performed to diagnosis and differential diagnosis. Two cases received the examination before transplantation and 18 cases received the examination after transplantation. RESULTS AND CONCLUSION： Hypersplenism and macrocytic anemia could be seen in the patients with orthotopic liver transplantation before transplantation. Graft versus host disease, plasma cell leukemia, leukemoid reaction, idiopathic thrombocytopenic purpura, hemophagocytic syndrome, metastatic hepatic carcinoma, agranulocytosis, acute hematopoietic cells stagnation and reactive thrombocytosis were shown after transplantation. Monitoring the effect of various complications in the perioperative period of liver transplantation on bone marrow hematopoietic function through bone marrow cytology examination has important significance for the treatment of patients with graft versus host disease.