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226例巨幼细胞性贫血临床病例分析 预览 被引量:1

Clinical Analysis of 226 Cases of Giant Cell Anemia
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摘要 目的:分析巨幼细胞性贫血血象和骨髓象细胞形态学特点以及叶酸、维生素B12定量检测结果,探讨巨幼细胞贫血细胞学形态特点及诊断与鉴别诊断的依据。方法:对226例巨幼细胞性贫血血象、骨髓象细胞形态学特点及空腹血清中叶酸、维生素B12定量检测结果进行回顾性分析。结果:巨幼细胞性贫血中,中、重度贫血占90.6%;多表现为一系、二系或三系细胞减少,细胞体积增大、细胞核分叶过多;骨髓细胞具有特征性的形态学特点:有核细胞增生活跃,红系以幼巨红细胞为主,粒红巨三系细胞均有巨幼变、核分叶过多,各阶段巨幼红细胞细胞核增大更明显,核染色质疏松呈网状,核发育晚于胞质,成熟红细胞以卵圆形大红细胞为主;叶酸和/或维生素B12降低占96.9%。结论:巨幼细胞性贫血的形态学特点是细胞巨幼变的典型性和显著性与中重度贫血共存;大细胞性贫血伴中性粒细胞核分叶过多表现可作为巨幼细胞性贫血的初检标准;骨髓中巨幼细胞生成增多和叶酸、维生素B12测定是诊断巨幼细胞性贫血的重要依据;巨幼细胞性贫血有显著的年龄特征,近年来中老年病例明显增多,传统的单纯营养性巨幼细胞性贫血的病例已明显减少。 Objective:To analysis of megaloblastic anemia hemogram and bone marrow cell morphology and quantitative detection results of folic acid and vitamin B12,explore the characteristics of cytology,diagnosis and differential diagnosis of giant cell anemia.Methods:226cases of megaloblastic anemia hemogram,bone marrow cell morphology characteristics and fasting serum folic acid,vitamin B12 quantitative detection results were retrospectively analyzed.Results:Giant cell anemia,moderate,severe anemia accounted for 90.6%;shown as a line,two lines or three lines cells decreased and increased cell volume,nuclear hypersegmentation;morphological characteristics of bone marrow cells with characteristic:active nuclear proliferation,to erythroid megaloblastic,grains are red giant three cells megaloblastic change,nuclear hypersegmentation,each stage of megaloblastic nuclei increased more significantly,the nuclear chromatin loose reticulation,nuclear development later than the cytoplasm,mature red blood cells with large oval red blood cell;folate and/or vitamin B12 decreased 96.9%.Conclusion:The morphological characteristics of megaloblastic anemia is typical and significant cells megaloblastic change in patients with moderate to severe anemia coexist;large cell anemia with neutrophil hypersegmentation performance as megaloblastic anemia initial inspection standard;gigantic young cell production in the marrow and folic acid,vitamin B12 and more determination is important for the diagnosis of megaloblastic anemia;megaloblastic anemia is a significant age characteristic,in recent years in elderly cases increased significantly,the traditional pure megaloblastic anemia cases has decreased.
作者 秦红群 马顺高 马稚强 杨国顺 何秋阳 QIN Hongqun, MA Shungao, MA Zhiqiang, et al. (Department of Laboratory, Dali People ' s Hospital, Dali Bai A utonomous Prefecture,Yunnan Province 671000)
出处 《医学理论与实践》 2017年第7期958-960,共3页 The Journal of Medical Theory and Practice
关键词 巨幼细胞性贫血 外周血 骨髓 细胞形态 诊断 鉴别诊断 Giant cell anemia Peripheral blood Bone marrow Cell morphology Diagnosis Differential diagnosis
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