MDS-RA\MgA与M6的骨髓细胞形态学鉴别诊断(1)
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[摘要] 目的：分析MDS-RA、MgA及M6患者骨髓细胞形态特点，以提高对相关疾病的认识。方法: 对在我院及上海瑞金医院确诊的25例MDS-RA，MgA及M6患者的骨髓细胞形态进行分析。结果：MDS-RA骨髓增生活跃或明显活跃，偶见增生减低，粒红比常减低，常见两系以上病态；MgA骨髓增生明显活跃，粒红比常减低，粒红两系出现巨幼样变；M6骨髓增生明显活跃，粒红比常倒置，红系明显病态，原始细胞增多。结论：MDS-RA，MgA及M6的骨髓象共同点：都会出现红系明显增生，出现巨幼样病态改变。不同点：MDS-RA与M6主要是各系病态造血明显，通常以原始细胞比例不同进行鉴别，而MgA主要表现为各系的巨幼样变,且原始细胞比例不高。
[关键词] 骨髓异常增生综合征难治性贫血(MDS-RA) 巨幼细胞性贫血(MgA) 急性红白血病(M6)
[中图分类号] R446.1[文献标识码] B [文章编号] 1673-7210(2011)02(c)-073-02
Differential diagnostic of bone marrow morphocytology in the patients with MDS-RA, MgA and M6
YU Yuanjun1, ZHANG Min2
(1.Department of Labs, the Third People's Hospital of Dalian, Liaoning Province, Dalian116033, China; 2.Affiliated Reijin Hospital of Shanghai Communication University, Shanghai200025, China )
[Abstact] Objective: To analyze the bone marrow morphocytology in the patients with MDS-RA, MgA and M6, deepen our understanding of related diseases. Methods: 25 cases diagnosed in our hospital and Shanghai Ruijin Hospital were analyzed. Results: MDS-RA of the bone marrow showed active or significantly active proliferation, occasionally showed hypoplasia.The ratio of G/E in bone marrow often reduced and more than two series were dysplastic. MgA of the bone marrow showed significantly active proliferation. The ratio of G/E in bone marrow often reduced and the bone marrow cells had a change of giants. M6 of the bone marrow showed significantly active proliferation. The ratio of G/E in bone marrow were often inverse. Erythrocytes were significantly dysplastic and the more ratio of blastocytes was found. Conclusion: MDS-RA, MgA and M6 of the bone marrow showed in common that erythrocytes were significantly active proliferation and the bone marrow cells had a change of giants. The differentia shows that the bone marrow of MDS-RA and M6 are dysplastic and have the different ratio of blastocytes. The bone marrow cells of MgA have a change of giants and the ratio of blastocytes is not high.
[Key words] Myelodysplastic syndrome refractory anemia (MDS-RA); Megaloblastic anemia (MgA); Acute erythroleukemia (M6)
难治性贫血(MDS-RA)、巨幼细胞性贫血(MgA)及急性红白血病 (M6)是三种不同性质的疾病，MDS-RA是一组造血功能异常的恶性克隆干/祖细胞性疾病；MgA是由于维生素B12和(或)叶酸缺乏，细胞DNA合成障碍导致细胞核发育障碍；M6是急性髓细胞白血病的亚型。全血细胞减少是MDS-RA，MgA及M6患者常见的外周血象变化，三者之间在外周血象及骨髓象上有某些相似之处，临床上易出现误诊，为了提高诊断水平，现将已明确诊断的25例患者进行回顾性分析。
1 材料和方法
1.1 患者来源
为2008年~2010年我院及上海瑞金医院明确诊断的25例初诊患者，年龄27~94岁。诊断标准依据第三版《血液病诊断及疗效标准》[1]。MDS-RA：12例，男7 例，女5 例；MgA：8例，男5 例，女3 例，M6：5例，男3 例，女2 例，患者年龄中位数分别为64.5、71、40岁。
1.2 方法
1.2.1 血常规检查日本希森美康XE2100全自动血液分析仪，使用配套试剂及质控品。显微镜：OLYMPUS CX21，血涂片经瑞氏染色，分类100个白细胞.
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