原发性骨髓纤维化伴巨脾患者脾切除术前后血常规动态观察

The impact of splenectomy on the blood routine examination in a patient with primary myelofibrosis and megalosplenia

目的探讨原发性骨髓纤维化(PMF)伴巨脾患者脾切除术对血常规的影响。方法对1例PMF伴巨脾患者脾切除术前后的血常规等指标进行动态观察,并对切除的巨脾进行组织学检查。结果患者术后呼吸困难、腹胀、纳差等症状明显好转。血常规结果示:白细胞明显升高,中性粒细胞百分比下降,淋巴细胞百分比升高,红细胞数变化相对较小,血红蛋白术后早期由于自体脾血回输升高,继之基本平稳,血小板变化最显著,术后明显减少,第5天最低仅10×109/L,后逐渐恢复正常。组织学检查可见脾脏出现骨髓化倾向。结论 PMF伴巨脾行脾切除后血常规改变明显,脾脏出现了部分代替骨髓造血的组织学改变,脾切除后机体血细胞计数逐渐恢复正常。对PMF伴脾脏巨大导致影响呼吸和消化功能的患者应予以切除脾脏。

Objective To explore the impact of splenectomy on the blood routine examination in a patient with primary myelofibrosis （ PMF） and megalosplenia. Methods Splenectomy was performed on a patient diagnosed with PMF and megalosplenia. Blood routine examinations were dynamically observed and histological examination was performed on the spleen.Results After splenectomy,the symptoms of dyspnea, abdominal distension and inappetence improved markedly.Leukocyte increased significantly.The percentage of neutrophils decreased while the percentage of lymphocytes increased. The change of erythrocyte was not obvious. Due to autologous blood transfusion, hemoglobin increased immediately after surgery, and then returned to normal level.Platelet fell to 10×10^9/L,and then increased gradually to normal level.Histological examination demonstrated that the spleen showed myeloid metaplasia. Conclusions Blood routine examination changes significantly after splenectomy is performed on the patient diagnosed with PMF and megalosplenia. The spleen shows certain bone marrow hematopoietic function. After splenectomy, the hematopoietic ability can still meet the need of the body.Thus,splenectomy should be performed on patients with injured respiratory and digestive function due to PMF？caused megalosplenia.