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Outcome of bone marrow in aplastic anemia hematological features of myelodysplastic syndrome


(+), Microscopic examination: WBC 500 × 10 / L, RBC 1580 × 10 / L,[link widoczny dla zalogowanych], did not find the tumor cells. Newly diagnosed tuberculosis exudative pleurisy, tuberculosis treatment 1O days, still fever and chest pain. July 5 blood: hemoglobin 62g / L, WBC 1.4 × 1O. / L, platelets 196 × 1O. / L, the original lymphocytes 0.43, bone marrow: bone marrow hyperplasia, accounting for 0.84 primary lymphocytes and peroxidase staining (P0x) leukemia cell 100 (a), glycogen staining (PAs)-positive rate of 17 Points 24 points, in line with acute lymphoblastic leukemia (L3 type). Diagnosed with acute lymphoblastic leukemia (L3 type), given VDP programs (vincristine, daunorubicin, prednisone) chemotherapy, 2 times the normal body temperature, chest pain relief, review chest pleural effusion completely absorbed, bone marrow show review partial remission, for economic reasons, to give up treatment. Example 2, M, 41, 26 days due to left chest pain, fever, cough 22 days on February 28, 2003 admission. February 2, 2003 there was no incentive to the left of severe chest pain, aggravated by deep inspiration,[link widoczny dla zalogowanych], no fever, the local hospital to check ECG, chest X-ray were normal, consider the 4 days later appeared on the left chest pain, accompanied by fever, cough,[link widoczny dla zalogowanych], chest X-ray: on the left costophrenic angle blunting,[link widoczny dla zalogowanych], pumping pleural effusion 150ml. Pleural effusion General: pale yellow, slightly mixed, Li Fan his test (+). Examination: case report of white cells 680 × 10 / L, RBC 960 × 10 / L, did not find tumor cells. February 7 blood: hemoglobin 110g / L, WBC 9.5 × 1O. / L, platelets 97 × 1O. / L, suspected of Physical examination: body temperature 39.2 ℃, mild anemia appearance, skin bleeding, superficial lymph nodes not palpable; sternum no tenderness, left lower lung breath sounds, heart rate 98 times / min, law Qi, no noise; abdomen soft, ribs no time liver, spleen and ribs 1cm, texture medium, no tenderness. Laboratory tests: hemoglobin 85g / L, WBC 46.23 × 1O. / L,[link widoczny dla zalogowanych], the original myeloid 0.24, promyelocytic 0.14, 0.08 rod granulocyte, granulocyte leaf 0.30, 0.24 lymphocytes, platelets 28 × 10. / L; urine: urine protein (A), urine occult blood (++); liver and kidney function normal. Chest X-ray showed: left pleural effusion. B-said: Hepatobiliary and Pancreatic normal kidneys, spleen, large and small to moderate amount of fluid left. Bone marrow: proliferation of nucleated cells was active, the original tablets of 0.32, promyelocytic 0.34. POX 0.91 (+++~++++), 0.09 (±~+), leukemic cells of non-specific esterase (NSE) leukemia cells 0.86 (a), 0.14 (±~+) granular staining of neutrophil alkaline phosphatase positive 0.08, points 8 points, consistent with acute non-lymphocytic leukemia (Mza). Ma diagnosis of acute non-lymphocytic leukemia type, to give DA programs (daunorubicin, cytarabine) chemotherapy 2, temperature is normal, absorption of pleural effusion, cough, chest pain relief, review of blood, bone marrow complete remission, is continuing chemotherapy. Discussion on acute leukemia with fever, anemia, bleeding, swollen lymph nodes and spleen as the main performance, pleural infiltration of leukemia cells can be induced exudative pleurisy and bloody pleural effusion, more common in acute lymphoblastic leukemia, can also be seen in acute non-lymphoid Ms leukemia type L1], from the cases of 2, the acute non-lymphocytic leukemia M2a type of acute leukemia in the pleura are also violations of pleurisy as the initial presentation, the doctor is not high vigilance, peripheral blood cells by the automatic blood cell analyzer numerical investigation of three lines in the normal range, not smear microscopy can not find abnormal cells, clinical easily misdiagnosed. Prompted by the case in clinical work, patients of pleural effusion, in addition to consider the common causes, the particular experimental treatment is ineffective, the need to rule out acute leukemia may, if necessary, the line of bone marrow cytology, while the peripheral blood smear should be examination as a routine examination, can help avoid some of leukemia misdiagnosis.