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- 请教各位老师
| 病人是我同事的母亲，因为贫血住院。骨穿：油滴（+++），增生低下，幼红未见，巨核未见，只见到部分杆状核及分叶核，骨髓小粒成空网架结构。单纯看骨髓象真像一个再障的骨髓象，可是粒系巨核系增生如此低下，为什么外周血白细胞正常？巨核未见，为什么外周血血小板正常呢？这么多血小板从哪儿来的呢？真是不好解释，又换部位穿刺，结果还是一样，都是穿的髂骨后。没有办法，去山东省立医院做的活检，结果结果出来是这样的结论：镜下见骨小梁及脂肪组织，未见骨髓组织。这个结论是什么意思？是取材不好还是怎么？请各位老师帮忙分析一下，谢谢了。 |
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I agree with everyone's opinion. If you have a normal or close to normal peripheral blood picture, you can not give a diagnosis of aplastic anemia. Another possibility. I had several cases in the past that patients had prostate or cervical cancers which were treated with radiation therapy locally. The peripheral blood study revealed mild anemia but the marrow was completely empty. I never got the history until I questioned the clinician about that. It seems very difficult to tell how long it takes for marrow to recover locally. In some situation, it may never happen.
| 以下是引用侯军在2010-5-3 11:43:00的发言： I agree with everyone's opinion. If you have a normal or close to normal peripheral blood picture, you can not give a diagnosis of aplastic anemia. Another possibility. I had several cases in the past that patients had prostate or cervical cancers which were treated with radiation therapy locally. The peripheral blood study revealed mild anemia but the marrow was completely empty. I never got the history until I questioned the clinician about that. It seems very difficult to tell how long it takes for marrow to recover locally. In some situation, it may never happen. 我同意每个人的观点。假如你有正常或者接近正常的外周血图像，你不能给一个再生障碍性贫血的诊断。另一个可能，过去我有一些病例，一些病人患有前列腺癌或者宫颈癌，进行局部的放射治疗。外周血检查显示轻微的贫血，但是骨髓却彻底的空虚了。我从来没有知晓过完整的病史，直到我询问临床医生才知道那些情况。要想知道骨髓局部的恢复正常需要多久的时间，这一点是非常困难的。在有些情况，它可能永远不会发生。 |
