严重营养不良继发全血细胞减少伴骨髓凝胶样改变两例报道并文献复习

Two cases of pancytopenia with the gelatinous transformation of the bone marrow secondary to malnutrition and literature review

严重营养不良影响淋巴造血系统,可以出现血细胞减少,严重全血细胞减少容易误诊为再生障碍性贫血。本文2例患者分别因神经性厌食和焦虑状态、疑病症进食减少,出现体重显著下降。实验室检查提示全血细胞减少,排除了感染、结缔组织病、淋巴增殖性疾病、化学物质及放射线损伤,因骨髓增生低下,造血细胞比例明显减少,曾考虑再生障碍性贫血。但结合病史,复核骨髓活检病理,发现骨髓粉染凝胶样物质。修正诊断为严重营养不良继发全血细胞减少伴骨髓凝胶样转化。既往研究发现营养不良通过影响造血细胞的产生和功能导致血细胞减少,体重显著下降,身体质量指数降低是主要危险因素,营养不良继发的全血细胞减少可逆,改善营养状况、恢复体重后可恢复正常,避免不必要的免疫抑制治疗。

Severe malnutrition affects the lymphopoietic system and can cause hemocytopenia.Severe pancytopenia is easily misdiagnosed as aplastic anemia.In this paper,2 patients had decreased eating due to anorexia nervosa,anxiety and hypochondriasis,and showed significant weight loss.Laboratory tests indicated total hemocytopenia,which ruled out infection,connective tissue disease,lymphoproliferative disease,chemical and radiation damage.Aplastic anemia was considered due to low myelodysplasia and significantly reduced hematopoietic cell proportion.However,combined with the medical history,the bone marrow biopsy pathology was reviewed,and it was found that the bone marrow powder was contaminated with the gel-like substances.The revised diagnosis was pancytopenia with gel-like transformation of bone marrow secondary to severe malnutrition.Previous studies have found that malnutrition affects the production and function of hematopoietic cells,leading to hemocytopenia and significant weight loss,and the decrease in body mass index is the main risk factor.The whole hemocytopenia secondary to malnutrition is reversible,and can be restored to normal after improving nutritional status and restoring weight,avoiding unnecessary immunosuppressive therapy.