BCR/ABL P230阳性的慢性粒细胞白血病特殊外周血检查结果分析

Special hematological manifestations of P230 BCR/ABL positive chronic myeloid leukemia in peripheral blood

目的分析1例BCR/ABL P230阳性慢性粒细胞白血病(CML)患者临床及实验室检查结果,与慢性中性粒细胞白血病(CNL)相鉴别,以提高对二者认识及诊治水平。方法收集患者临床资料及实验室检查,包括血象、骨髓象、组织化学染色、染色体检查、融合基因检测等进行综合分析。结果血常规:无贫血,白细胞、血小板增多,多次白细胞分类:中性粒细胞均>0.86。骨髓象:有核细胞增生极度活跃,粒系增生,以中晚期粒细胞为主,嗜酸粒细胞及嗜碱粒细胞易见;巨核细胞增生,血小板成堆多见。组织化学碱磷酶染色阴性。Ph染色体阳性,t(9;22)(q34;q11),BCR断裂点在μ区,与μ-BCR相应的有e19a2,其编码蛋白为P230。结论这种Ph+BCRμ区基因重排应诊断为CML,而不应诊断为CNL,无Ph染色体和BCR/ABL融合基因才是真正的CNL。

Objective To analyze the clinical and special laboratory features of one case with BCR/ABL P230 positive chronic myeloid leukemia（CML）patient through reviewing comprehensive literature and to identify the disease with chronic neutrophilic leukemia（CNL）and improve the level of diagnosis and treatment.Methods Laboratory tests included routine blood examination,bone marrow,histochemical staining,chromosome examination,detection of fusion gene and analysis comprehensively.Results Routine blood test did not show anemia,but increased white blood cells,platelets,many times white blood cell classification：neutrophil all〉0.86.The bone marrow showed very active and active proliferation of nuclear cells,and the proliferation of the cells in the middle and late stage,and eosinophils and basophils easily seen.Tissue chemical staining of alkali phosphatase was negative.Ph chromosome positive,t（9;22）（q34;q11）,BCR breakpoint was in the μ-BCR,with the corresponding BCR of e19a2,coding protein was P230.Conclusion The Ph＋BCR gene rearrangement should be diagnosed CML,and not diagnosed as CNL,no Ph chromosome and BCR/ABL fusion gene is the real CNL.