非典型急性白血病九例误漏诊临床分析

Clinical Analysis of 9 Misdiagnosed or Missed Diagnosis Patients with Atypical Acute Leukemia

目的探讨非典型急性白血病(AL)的误漏诊原因,提高诊治水平。方法对我院2008年1月—2016年5月收治的9例以非典型临床症状为首发表现的AL的临床资料进行回顾性分析。结果本组误漏诊时间为(12.20±8.36)d,误诊为粒细胞缺乏症2例,败血症、血小板减少性紫癜、风湿热伴风湿性节炎各1例;漏诊4例,其中诊断为消化性溃疡伴荨麻疹2例,慢性胃炎伴荨麻疹、钩虫病伴继发性贫血各1例。所有患者均行骨髓穿刺细胞学检查,确诊为急性淋巴细胞白血病4例,急性嗜碱粒细胞白血病3例,急性粒细胞白血病2例。2例行骨髓移植治疗,7例行化疗及对症治疗,均病情好转出院。随访3年,病情平稳,未见复发。结论遇及以不典型症状为首发表现的血液系统异常的患者时,要考虑到AL可能,及时行相关实验室检查,争取早诊断、早治疗,改善预后,降低误漏诊率。

Objective To investigate causes of atypical acute leukemia （AL） in order to improve levels of diagnosis and treatment. Methods Clinical data of 9 AL patients having atypical symptoms as primary manifestation admitted during January 2008 and May 2016 was retrospectively analyzed. Results The misdiagnosed and missed diagnosis time of the 9 pa- tients was （12.20 ± 8.36）d. Among the 9 patients, 2 patients were misdiagnosed as having agranuloeytosis; 1 patient was misdiagnosed as having sepsis; 1 patient was misdiagnosed as having thrombocytopenic purpura; 1 patient was misdiagnosed as having rheumatic fever associated by rheumatic arthritis ; among 4 missed diagnosis patients, 2 patients were diagnosed as hav- ing peptic ulcer associated by urticaria; 1 patient was diagnosed as having chronic gastritis associated by urticaria; 1 patient was diagnosed as having hookworm disease associated by secondary anemia. All patients received bone marrow aspiration cyto- logical examination, acute lymphoblastic leukemia was confirmed in 4 patients, acute basophilic leukemia was confirmed in 3 patients, and acute myeloblastic leukemia was confirmed in 2 patients. After diagnosis, 2 patients were treated with bone mar- row transplantation, and 7 patients were treated with chemotherapy and symptomatic treatment, and then all patients were dis- charged after improving conditions. All patients had stable conditions without recrudescence during 3 years of follow-up. Con- clusion Clinicians should consider the possible of A1 for patients with atypical symptoms and abnormal hematological system as primary manifestation, and give related examinations early in order to decrease misdiagnosed and missed diagnosed rates by diagnosis and treatment early and prognosis improvement.