以顽固性低钾、低钙血症为主要起病表现的慢性粒-单核细胞白血病一例

A Case of Chronic Myelomonocytic Leukemia: the Onset of which was Manifested by Hypokalemia and Hypocalcemia

顽固性低钾、低钙血症发生于白血病较少见,可能涉及多种机制。本文回顾性报道一例慢性粒-单核细胞白血病(CMML)合并顽固性低钾、低钙、低氯、低镁血症患者。该患者男性,48岁,乏力、恶心、面颊麻木1月余。外周血单核细胞明显增多,骨髓单核细胞比例升高,确诊为慢性粒-单核细胞白血病。同时发现顽固低钾、低钙、低氯、低镁血症,血肌酐升高,代谢性碱中毒及大量蛋白尿,醛固酮、肾素水平升高。行2个疗程阿扎胞苷治疗及支持治疗后,骨髓达完全缓解,除低镁血症未完全纠正,其他电解质恢复正常。现对该例患者的临床特点进行分析总结,以提高对该临床情况的认识。

Intractable hypokalemia and hypocalcemia are rare complications in leukemia patients. This article reports a patient with chronic myelomonocytic leukemia(CMML)with refractory hypokalemia, hypocalcemia, hypochloridemia, hypomagnesemia-a 48-year-old man complained of fatigue, nausea, and face numbness for over one month. The number of monocytosis in peripheral blood and bone marrow increased remarkably. At the same time, the patient developed hypokalemia, hypochloridemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, massive proteinuria, and increase in plasma aldosterone and renin. After two coursea of treatment using Azacitidine therapy, complete remission of bone marrow was achieved and the electrolyte disturbance was almost corrected, except hypomagnesemia. We summarize the clinical characteristics of the patient so as to raise the clinical awareness of such cases.