低增生性骨髓增生异常综合征与再生障碍性贫血的检查诊断

Diagnosis and differential diagnosis between hypoplastic myelodysplastic syndrome(Hypo-MDS) and aplastic anemia(AA)

目的探讨外周血涂片、骨髓细胞学、骨髓病理学联合检查在低增生性骨髓增生异常综合征(Hypo-MDS)与再生障碍性贫血(AA)诊断与鉴别中的价值。方法对11例Hypo-MDS和43例AA患者的外周血,骨髓细胞涂片和骨髓组织进行观察。结果 Hypo-MDS与AA患者外周血均表现为三系细胞减少,Hypo-MDS患者中8例有成熟红细胞形态异常;2例检出原始和/或幼稚细胞。骨髓细胞检查:Hypo-MDS粒、红、巨三系病态造血分别为72.72%、100%、72.72%。AA患者主要表现为粒系、红系、巨核系三系细胞减少。骨髓组织检查:Hypo-MDS和AA均表现为造血组织减少,Hypo-MDS红系、粒系和巨核系形态异常分别为81.82%、63.64%和45.45%。16.28%的AA患者表现为红系形态异常。结论外周血涂片、骨髓细胞学、骨髓病理学联合检查,对于Hypo-MDS和AA诊断和鉴别具有重要价值。

Objective To explore the joint detection value of peripheral blood smear, bone marrow cytology and bone marrow pathology in diagnosis and differential diagnosis between hypoeellular myelodysplastic syndrome （Hypo -MDS） and aplastic a- nemia （AA）. Methods Peripheral blood samples were collected from 11 hypo - MDS cases and 43 AA patients to observe the bone marrow cell smear and bone marrow tissue. Results Peripheral blood smear results showed hypo - MDS cases and AA pa- tients all showed decrease of leukocytes, erythroeyte and platelet, and in 11 hypo - MDS cases, 8 cases were detected abnormal mature red blood cells and 2 cases were detected the primitive cells and/or juvenile cells. Bone marrow cells examination showed the proportions of granular leukocytes dysplasia, erythroid cell dysplasia and megakaryocytes dysplasia were 72.72% , 100% and 72.72% in hypo - MDS eases, while AA patients mainly showed leukoeytes, erythrocyte, megakaryoeyte decrease. Bone marrow tissue examination showed hemotopoietic tissue decreased in hypo - MDS cases and AA patients, the morphology abnormal rates of granular leukocytes, erythroid cells and megakaryocytes were 81.82% , 63.64% and 45.45% in hypo - MDS cases, while the erythroid cell dysplasia was found only in 16.28% of the AA patients. Conclusion The joint inspection of pe- ripheral blood smear, bone marrow cytology and bone marrow pathology have important value in diagnosis and differential diag- nosis between hypo -MDS and AA.