再障患者转化为急性白血病二例病例报道及文献复习

孙爱红 王方方 管俊 谢晓艳 马莉

摘要：目的：回顾分析二例诊断为再障患者，半年后复查骨髓已为急性白血病（M2），分析其转变的可能原因。方法：回顾分析二例患者初诊时资料，如基本临床资料，血常规中红细胞参数，如红细胞平均体积、平均血红蛋白量，及多部位骨髓涂片特点；进一步分析治疗方法，尤其强化免疫抑制治疗对转化的影响。结果：二例患者因贫血就诊，初诊时经过骨髓涂片、活检诊断为再障，一例仅给予安雄及再造生血片促造血治疗，另一例强化免疫抑制治疗效果不明显，两例患者均在半年后复查骨髓诊断为急性白血病。

关键词：再障、急性白血病、转变、强化免疫治疗

Abstract：Purpose ： Two cases diagnosed as aplastic anemia ， who were diagnosed as acute leukemia （M2） six months after one patient had received promoting hematoietic activity and another patient had received intensive immunosuppressive therapy including ATG and cisclosporine（CsA）， were retrospectively analyzed. Methods ： They was retrospectively analysed about her basic information such as clinical data， periperal blood red blood cell（RBC） parameters including mean corpuscular volume（MCV）， mean corpuscular hemoglobin（MCH）， and characteristics of multi - site bone marrow smear. Their treatments were also retrospectively analyzed. Results： Two patient initially diagnosed as severe aplastic anemia by aspiration and biopsy of their bone marrow had received promoting hematopoietic activity in one patient and intensive immunosuppressive therapy including p-ATG and CsA therapy in another patient but there were no significant effect. Their bone marrow reports six months after presented with acute myelocytic leukemia.

Keywords ： aplastic anemia， acute myelocytic leukemia， transformation， intensive immunosuppressive therapy

1、病例資料

1.1患者，女性，48岁。面色苍白半年，本院门诊查血常规示三系减少，为进一步诊治收入。体征示中度贫血貌，全身皮肤粘膜散在出血点、瘀点。辅助检查：血常规：Hb71g/L，WBC 1.4×109/L，N 0.32×109/L，PLT 14×109/L。网织红细胞0.46%。尿常规示（-）。生化及免疫未见异常。心电图、胸片及腹部彩超等未见异常。骨髓涂片示增生减低，粒系21%，红系24%，淋巴系52%，巨核细胞未见。染色体核型示（46，XX）。同时骨髓活检提示造血组织减少，脂肪增多，建议排除再障。复查胸骨骨髓示增生活跃，巨核细胞1枚，淋巴细胞等非造血细胞比例明显升高。诊断：再生障碍性贫血。治疗：其因经济问题未同意ATG+CsA治疗，带药再造生血片、安雄、维生素B6等口服出院，门诊随诊（血常规三系恢复不明显）。六月后复查血常规示白细胞36×109/L再入院，复查骨髓提示增生明显原始细胞71%，POX（+），免疫分型示髓系表达，染色体46，XX核型。……