多发性骨髓瘤与反应性浆细胞增多症细胞形态学的探讨

Investigation of cell morphology in multiple myeloma and reactive plasmacytosis

目的探讨多发性骨髓瘤(MM)与反应性浆细胞增多症(RP)患者细胞形态学特点,以提高二者的鉴别水平。方法对MM和RP血片、骨髓片应用瑞氏染液染色后镜检,观察红细胞排列及浆细胞形态。血片分类计数100个有核细胞,骨髓片计数500个有核细胞,分别计算出浆细胞的百分数。结果 MM患者外周血可见到浆细胞,红细胞呈缗钱状排列,骨髓浆细胞数量较多,核异型性明显,浆细胞成簇分布。RP患者外周血浆细胞少见,红细胞呈缗钱状排列不明显,骨髓浆细胞数量较少,核异型性不明显,浆细胞散在分布。结论 MM与RP在细胞形态学方面具有相似性,易混淆,骨髓细胞形态学检查是诊断二者的基础。

Objective To investigate characteristics of cell morphology in multiple myeloma（MM） and reactive plasmacytosis（RP）, in order to improve identification of this two diseases. Methods Microscopic examination was made for blood smear and bone marrow smear of MM and RP after stained by Wright＇s stain. Arrangement of erythrocyte and form of plasmocyte were observed. Differential counting required 100 karyocytes in blood smear and 500 karyocytes in bone marrow smear for calculating proportion of plasmocyte. Results MM patients had visible plasmocyte and rouleanx erythrocyte in peripheral blood, with a large amount of marrow plasmocyte. Their plasmocyte was in cluster distribution with obvious nuclear abnormality. RP patients had few plasmocyte and unobvious rouleanx erythrocyte in peripheral blood, with a few marrow plasmocyte. Their nuclear abnormality was not obvious, and plasmocyte was in scattered distribution. Conlcusion MM and RP show similarity in cell morphology, and that may lead to misdiagnosis. Bone marrow cell morphology is the basis for diagnosis of these two diseases.