Abasabela Leukemoid ebantwaneni: iintlobo (species), oonobangela, unyango algorithm isifo. reactions Leukemoid kunye leukemia: iiyantlukwano

indlela Leukemoid - litshintsha hematopoiesis, ezifana igazi ezisemfanekisweni ileukemia kunye nezinye nangezilonda yenkqubo hematopoietic. Kufuneka kuqatshelwe ukuba ingakumbi kwezi ziphumo na isini sabo esebenzayo kunye nokunqongophala utshintsho in umhlaza. Ezi basabele kuxhokonxwa iintlobo ezahlukeneyo intoxications, nangezilonda, izifo, wobuchopho kuwenza.

Indlela yophuhliso yahluka kunye neentlobo ezahlukeneyo abasabela: kwezinye iimeko ukuba abafundi abagqibayo izinto legazi ubuntwana, kwabanye - ukwanda kwemveliso kwiiseli okanye isithintelo kweeseli abagqibayo a tissue, okanye ubukho iindlela eziliqela ngaxeshanye.

ingaba yintoni umthombo esi sifo?

Zininzi izinto ezinokuthi zenzeke reaction ngenxa leukemoid. Izizathu kuphuhliso lwabo zezi:

• kwempembelelo ionizing radiation;
• tuberculosis;
• nokudumba;
• iinkqubo ubovu;
• nokuxaxaza igazi;
• isifo Hodgkin kaThixo;
• ukuphatheka cranial;
• athuke;
• lobar pneumonia;
• erysipelas;
• umphimbo;
• fever ebomvu;
• muscular sisibindi;
• therapy corticoid;
• carbon monoxide.

isifo imihlobo

Ezi ndidi zilandelayo reactions leukemoid:

• basabela Myeloid.
• Lymphocytic.
• Psevdoblastnye.

Makhe siqwalasele nganye ngokweenkcukacha.

myeloid

Ngale ndlela yokusabela ziquka ezifana neutrophil, eosinophil kunye promyelocytic. neziphumo Leukemoid efanayo naleyo wegazi esingapheliyo myeloid, ekhatshwa ukunxila kunye nosulelo kakhulu. leukocytosis Active kukulawula usoloko yinkqubo enzima sikhatshwe ubukho nokudumba, nakujoliso olutsha kwiintetho ezikralayo, yaye iqondo lobushushu emzimbeni zanda.

Exposure ezingaphezu eosinophils egazini badla kwenzeka xa zegazi ukuba izinambuzane kunye neziyobisi, diathesis negazi, kunqabile - xa izifo oncological (isifo Hodgkin kunye lymphosarcoma). Ezi khemikhali leukemoid isidingo sokuba uphando olubanzi kwizifo idilesi inkqubo yokujikeleza kwegazi, akugubungele amanundu.

iiseli Ukukhathalela ezifana eritremii. imiba polycythemia - kudla ukuhla nezifo zamaphaphu oxygenation (oxygenation) igazi, nangezilonda zezintso, kunye nesifo sentliziyo naso. Le meko ifuna ikhompyutha ultrasound.

Mielemiya efana erythroleukemia etsolo, eyahluke kuphela ukunqongophala iliza erythrocytes kumongo amathambo kunye negazi. Idla kuyenzeka ukubona metastases izifo ithambo.

lymphocytic

Ezi abasabela luphawulwa ukunyuka kakhulu inani lilonke lymphocyte egazini peripheral, nto leyo edla onoxanduva ukwanda kwesibindi, kwiindawo nkovu kunye udakada.

Kule hlobo fanele mononucleosis, ezosulelayo lymphocytosis, reactions monocyte-macrophage leukemoid ebantwaneni kunye kwezifo kunye wentsholongwane egazini, kunye nosulelo olwaye lwamfimfitha kunye eosinophilia lwegazi (umz, helminthiasis).

reactions Lymphocytic zenzeke:

• amagciwane (chicken pox, rubella, uqilikwane, usuleleko adenovirus, imasisi, mononucleosis esosulelayo);
• izifo olwaye lwamfimfitha (rikketsiozah, toxoplasmosis, chlamydia);
• usulelo bacteria (negcushuwa, pertussis, isifo sephepha);
• mycoses ezahlukeneyo;
• Izifo komzimba (isifo serum, systemic lupus zomzimba).

uhlobo Lymphocytic landile macroglobulinemia Waldenstrom, nangokurhala, sarcoidosis. Zonke izifo ngasentla baphathwa nzulu kakhulu kwaye lisenokubhidekisa kumguli ngaphezu konyaka.

Psevdoblastnye

reactions ezinjalo leukemoid ukuba isigulane ekuqaleni kuphela kuvela agranulocytosis omzimba, unobangela apho kuxhokonxwa ulwamkelo sulfonamides, "aminopyrine," "butadiene" kunye nezinye iziyobisi.

Kuba neziphumo ezinje iqela luphawulwa phambi egazini kunye lomongo wethambo inani peripheral elikhulu components zeselula kunye engundoqo bomzi, kunye nucleoli single oluhlaza, zingcakacile, hayi ukuba kukho icytoplasm granular.

Ngokungafaniyo bekhalisa eqhelekileyo erythrocytes kwezi iinethiwekhi babe imicu ezithile chromatin ethambileyo kunye kulinganiswa. blastosis mgaqweni anyamalale ngaphandle ichemotherapy kunye neempembelelo ezinxulumene leukemoid zifumaneka iintsana ezisanda kuzalwa kunye nezigulo chromosomal yemfuza (umzekelo, Down syndrome).

Iintlobo indlela Leukemoid ezithe uchazwe apha ngasentla, apho kwakheka kwi imvelaphi yazo naziphi na ngezifo, ngokuqhelekileyo musa kunokubangela iingxaki eziyingozi. Ngamanye amaxesha kakhulu wabonakala thrombocytopenia kusenokwenzeka ngempazamo kuthathwa njengomnye iimpawu wegazi ahlekise. Ukubonwa immunoblastic lymphadenites ebaluleke kakhulu kukuba ukhuseleko ubume bendalo esiludumbo nkovu, kwakunye ukujonga ngokuchanileyo ilayini zoboya.

reactions Leukemoid kunye leukemia: iiyantlukwano

Kukho umahluko phakathi iziphumo ezifana ne wegazi, ezizezi:

1. Xa reactions lobomi leukemoid intanethi lomongo wethambo okukhawulezayo, oko metamielotsitarnym kwaye kubonakele nokwanda iifom leukemia udubulo. Xa imiphumela leukemoid kusindiswa erythroid intsholongwane, kukho leykoeritroblasticheskoe ratio eqhelekileyo - 3: 1 no-4: 1.
2. Hayi obubonakala okubonakala of anaplasia kunye nesenzeko leukemoid njengoko kwenzeka ileukemia xa kukho equmbile le protoplasm kunye anomaly isiqalo.
3. In lwalo yokuqala, egazini peripheral ukwanda kwenani eliphezulu nepesenti yezo ukwanda neutrophils abaqolileyo kwikhontenti leukemia kunciphisa neutrophils abaqolileyo kwenzeka ukwanda ngokugqithisileyo entsha, iifom akuqolanga.
4. Xa reactions leukemoid rhoqo waphawula imbudumbudu eyityhefu of neutrophils.
5. Xa leukocytes isifundo cytochemical kwi ileukemia ukuncipha okanye ukungabikho i phosphatase obrak, xa reactions leukemoid - umsebenzi kwalo.
6. Ngexesha exacerbation bezifo myeloid leukemia udubulo ingxaki umanduleli na eosinophilic, ukunxulumana basophilic kunye reactions leukemoid intanethi.
7. Xa leukemia myeloid idla thrombocytosis ophezulu, kunye reactions leukemoid zegazi ukubala ngaphakathi kuluhlu yesiqhelo.
8. Kumanqanaba okuqala wegazi ezingapheliyo myeloid ukufumana udakada enkulu ngci kwi reactions leukemoid maxa wambi kwenzeka splenomegaly, kodwa ke umzimba wona uthambile yaye ufikelela ubungakanani enkulu kakhulu.
9. Xa reactions leukemoid kwinkqubo neoplastic ibonakele iiseli umhlaza umongo wethambo.

abasabela Leukemoid kubantwana: algorithm diagnostic

indima ebalulekileyo lokufunyaniswa kwesifo anikwe histopathology ukuba uphonononga izinto biopsy. Kodwa ukuze aphephe iimpazamo noqhekeko, lo sezifo kufuneka iqokelele ulwazi oluchanekileyo malunga isigulane, amnike ulwalathiso iimvavanyo ezahlukeneyo ukuze amisele unyango cytostatic, olususa zonke imiphumo lymphadenitis. Ukuba yonke akwenzeki oku, uxilongo kwenziwa ngokuchanekileyo, ngoko ke ukumelana nesi sifo iya kuba nzima kunene. Ngapha koko, le sifo kuyingozi kakhulu. Ngamanye amaxesha, ngokuba ekuphelisweni iinkcukacha eziyimfuneko ukwenza biopsy phinda.

ukubaluleka elininzi ekufunyanisweni kwe-smear ukubonakala nkovu biopsies esiludumbo kunye yamanyala. Xa uninzi lymphosarcoma erythrocyte (30 ubuncinane ekhulwini) kwixabiso iiseli rhoqo udubulo. Ekubeni erythrocytes ezinjalo lymphadenitis immunoblastic, idla ngaphantsi kwe-10 pesenti, zahluke ngokwemigaqo basophilia ye kukho icytoplasm nokuvuthwa isiqalo.

diagnosis Histopathological kuhlalutyo nkovu node kufuneka eneenkcukacha kakhulu kwaye ngaphandle kwisigqibo engachananga. Ngenxa histopathology izifundo ezahlukeneyo igazi kufuneka achaze ngokucacileyo uxilongo, yaye oku kuboniswe esiphelweni. Umzekelo, ngenxa uxilongo lokuqala lymphoma nabungozi, kwezinye iimeko, ixesha elide ukuba bagcine isigulane kwaye uhlole iindawo nkovu kwakhona.

Uxilongo ngayo leukemoid kuyakrokreleka xa uzingela immunoglobulin monoclonal ngamanye amaxesha kufuneka afumane i-phindwa kwaye kugcinwa ixesha elide ezinomongo wethambo okuhlatywa. Phambi koqwalaselo kwesifo somhlaza chemotherapy into contraindicated.

isifo ukwanga

Enye nesifo ekuthiwa Filatov - Pfeyferra, icesina glandular kunye angina monocytic. Sisifo wentsholongwane esibonakala iinguqu lymphocyte nokuphalazeka kwelifu, iindawo ezandisiweyo nkovu kunye udakada, lymphadenitis lovukelo, kukuvela iiseli ezithile ezibomvu egazini peripheral. Iarhente causative kuthathwa Epstein-Barr yintsholongwane. Isiseko kwesifo - inguqu ukufutha lymphocyte ezibangelwa usuleleko olulodwa lohlobo.

Imeko yinto eyahlukileyo. Xa iintlobo onomoya of nokuthimliswa ngenxa yokuqhekeka. features Imiboniso:

• angina ( "emqaleni evuthayo ');
• wawandisa udakada kunye zamanzi kwakunye buhlungu;
• ngeempumlo ukuphefumla nzima ngemihla yokuqala sifo ngenxa ekweneni isifo.

Isimo igazi: ukunyuka ngokwepesenti eosinophils, lymphocyte kunye monocytes.

ukungaphili

Kuyimfuneko kwaye zanele nowokupheliswa sisalathisi esi sifo phambi kwi original mononuclear igazi (ngaphezu 10-20%) - iiseli ukuba kwahluka lymphocyte nucleus kukho icytoplasm enkulu kunye ngokubanzi basophilic nge eyahlukileyo umbala Lilac kunye ukukhanyiselwa perinuclear libizwe. Indlela yokugqibela leukemoid abantwana kunye nabantu abadala kangangeeveki eziliqela, kodwa iinyanga uyaqhubeka kwiimeko ezithile, ukuba kuqheleke imeko igazi.

Kunye likakade baqondisiswa ngomoya wobulali, maxa wambi emva kwesithuba seminyaka eliqela emva kwixesha lokuqala bukhali. Ezinobuzaza kungabandakanya:

• hepatitis olunamandla;
• kobuchopho;
• agranulocytosis;
• uqhekeko splenic okubangelwa ukwanda ngamandla;
• hemolysis komzimba.

Therapy ngayo leukemoid

Njengomgaqo, izigulane musa ukuba amayeza ekhethekileyo, kuba iintsuku ezimbalwa iimpawu eziphambili sifo ngokuyinqaba kwaye imeko igazi eqhelekileyo. Xa zinde ukugula kunye nesigulana isaqala kusetyenziswa unyango pathogenetic - ityumbe "prednisolone" xa umthamo we-20-30 mg ngosuku okanye namanye amachiza glucocorticoid ukwenzela ukuphelisa indlela leukemoid. Unyango kuyo nayiphi na imeko, simisa kuphela ingcali.

Outlook

Ngokuqhelekileyo HIV: contagiousness ayikho phezulu, ngoko ke isigulane asifuneki yedwa. Noko ke, yingozi komsipha le udakada. Ukulungisa zokunciphisa volume emiselwe iimpawu Ukubonakala umzimba kunye yokuduka angina kuqheleke lobushushu bomzimba. Ukuba mononucleosis ezosulelayo esibonakaliswa ngohlobo kwesibindi, isigulane esibhedlela.