全血细胞减少的鉴别诊断
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❖ Signs:
hepatosplenomegaly:not in AA, MDS, PNH, MA lymphadenopathy:lymphoma, leukemia, CTD, some infectious diseases
Diagnostic procedure
－lab findings
全血细胞减少的鉴别诊断
Differential diagnosis of pancytopenia
Definition
Peripheral blood ❖ WBC<4.0×109/L ❖ Hgb<100g/L ❖ PLT<100×109/L
张之南主编，《血液病诊断与疗效标准》，北京科学 出版社，1998
MA
MA
MA
MA
MF
MF
MF-PB
MF-PB
Tumor metastasis
Tumor metastasis
Tumor metastasis
Tumor metastasis
Tumor metastasis
Diagnostic procedure
－BM biopsy
❖More precise than cytology in AA, MF, tumor metastasis
Case 1
❖ M82, C871049 ❖ 面色苍白4-5年，加重伴乏力2月 ❖ PE:贫血貌，LN(-)，心肺(-)，肝脾不大 ❖ CBC:WBC 2.23G/L, N57%, HB 68g/L, MCV 119fl
PLT 44G/L, Ret 2.66% ❖ DC: normal Questions: ❖ History information ❖ Other tests
❖ Blood biochemistry: Tbil↑IDbil:HA, MA LDH↑:HA, MA, malignancies
❖ Urine: Rous+: PNH UBG↑:HA Bil+: liver disease
Diagnostic procedure
－BM aspiration
❖ Cellularity ❖ G:E=2-4:1 ❖ Morphrology and ratio of different
lineages ❖ Dysplastic hematopoiesis ❖ Abnormal cells ❖ Parasites
AA
AA
AA
AA
AA
AA
MDS
MDS
MDS
MDS
MDS
MDS
MDS
MDS
AL
AL
AL
Lymphoma leukemia
Lymphoma leukemia
Diagnosis: MA
Case 2
❖ F57, C873149 ❖ 反复头晕，皮肤淤斑8年，间断排酱油色尿2年，腹胀1月 ❖ PE: 皮肤巩膜黄染，LN(-)，贫血貌，心肺(-)，肝脾未及，
移浊（＋） ❖ CBC：WBC 2.93G/L, HB 55g/L, MCV 117fl,
Fra Baidu bibliotek
General introduction
❖ 血液系统疾病是导致全血细胞减少的主要原因， 非血液病占10-30%不等。
❖ 临床结合骨髓检查（细胞学和组织学）90%以 上的患者可明确病因。
❖ 注重伴随症状、体征的改变。
Hematological etiology
❖ Aplastic anemia(AA) ❖ Myelodysplastic syndrome(MDS) ❖ Malignancies: acute leukemia, multiple
prostate, breast ❖ Autoimmune diseases: SLE, RA ❖ Infectious diseases: typhoid, TB,
septicemia, Kala-azar, virus
Diagnostic procedure
－clinical manifestation
❖ Symptoms:
fever:malignancies(rare in MM,MDS), infectious diseases, CTD bone pain:malignancies joint pain:CTD, acute leukemia jaundice:hemolytic anemia, megaloblastic anemia, hepatitis
Answers
❖ 平素偏食，不食肉类和牛奶 ❖ SI, TIBC, TS, SF均正常 ❖ FA 14.5ng/ml, VitB12 72pg/ml(>150) ❖ BM: 大致正常？，部分RBC淡染区轻度扩大 ❖ CD55, CD59阴性细胞<RBC和中性粒细胞5% ❖ 溶血检查：(-)
❖ PCA-Ab (+), 内因子抗体(+)
❖ CBC: Lymphocyte↑:viral infection, AA Ret↑:hemolytic anemia(HA), ↓:AA MCV↑:MA, HA, MDS
❖ DC: blasts:leukemia, MDS, MF RBC teardrop cells, nucleated cells: MF
❖More precise to evaluate marrow cellularity hematopoietic tissue:fat=100-age:age
Diagnostic procedure
－other tests
❖ Culture ❖ CXR, PPD ❖ Auto antibodies ❖ Imaging ❖ Hepatitis testing ❖ Folic acid and VitB12 ❖ Hemolytic tests, including CD55,CD59
myeloma, lymphoma ❖ Megaloblastic anemia(MA) ❖ Paroxysmal nocturnal hemoglobinuria(PNH) ❖ Myelofibrosis(MF)
Nonhematological etiology
❖ Cirohsis hypersplenism ❖ Nonhematological malignancies:lung, GI,
hepatosplenomegaly:not in AA, MDS, PNH, MA lymphadenopathy:lymphoma, leukemia, CTD, some infectious diseases
Diagnostic procedure
－lab findings
全血细胞减少的鉴别诊断
Differential diagnosis of pancytopenia
Definition
Peripheral blood ❖ WBC<4.0×109/L ❖ Hgb<100g/L ❖ PLT<100×109/L
张之南主编，《血液病诊断与疗效标准》，北京科学 出版社，1998
MA
MA
MA
MA
MF
MF
MF-PB
MF-PB
Tumor metastasis
Tumor metastasis
Tumor metastasis
Tumor metastasis
Tumor metastasis
Diagnostic procedure
－BM biopsy
❖More precise than cytology in AA, MF, tumor metastasis
Case 1
❖ M82, C871049 ❖ 面色苍白4-5年，加重伴乏力2月 ❖ PE:贫血貌，LN(-)，心肺(-)，肝脾不大 ❖ CBC:WBC 2.23G/L, N57%, HB 68g/L, MCV 119fl
PLT 44G/L, Ret 2.66% ❖ DC: normal Questions: ❖ History information ❖ Other tests
❖ Blood biochemistry: Tbil↑IDbil:HA, MA LDH↑:HA, MA, malignancies
❖ Urine: Rous+: PNH UBG↑:HA Bil+: liver disease
Diagnostic procedure
－BM aspiration
❖ Cellularity ❖ G:E=2-4:1 ❖ Morphrology and ratio of different
lineages ❖ Dysplastic hematopoiesis ❖ Abnormal cells ❖ Parasites
AA
AA
AA
AA
AA
AA
MDS
MDS
MDS
MDS
MDS
MDS
MDS
MDS
AL
AL
AL
Lymphoma leukemia
Lymphoma leukemia
Diagnosis: MA
Case 2
❖ F57, C873149 ❖ 反复头晕，皮肤淤斑8年，间断排酱油色尿2年，腹胀1月 ❖ PE: 皮肤巩膜黄染，LN(-)，贫血貌，心肺(-)，肝脾未及，
移浊（＋） ❖ CBC：WBC 2.93G/L, HB 55g/L, MCV 117fl,
Fra Baidu bibliotek
General introduction
❖ 血液系统疾病是导致全血细胞减少的主要原因， 非血液病占10-30%不等。
❖ 临床结合骨髓检查（细胞学和组织学）90%以 上的患者可明确病因。
❖ 注重伴随症状、体征的改变。
Hematological etiology
❖ Aplastic anemia(AA) ❖ Myelodysplastic syndrome(MDS) ❖ Malignancies: acute leukemia, multiple
prostate, breast ❖ Autoimmune diseases: SLE, RA ❖ Infectious diseases: typhoid, TB,
septicemia, Kala-azar, virus
Diagnostic procedure
－clinical manifestation
❖ Symptoms:
fever:malignancies(rare in MM,MDS), infectious diseases, CTD bone pain:malignancies joint pain:CTD, acute leukemia jaundice:hemolytic anemia, megaloblastic anemia, hepatitis
Answers
❖ 平素偏食，不食肉类和牛奶 ❖ SI, TIBC, TS, SF均正常 ❖ FA 14.5ng/ml, VitB12 72pg/ml(>150) ❖ BM: 大致正常？，部分RBC淡染区轻度扩大 ❖ CD55, CD59阴性细胞<RBC和中性粒细胞5% ❖ 溶血检查：(-)
❖ PCA-Ab (+), 内因子抗体(+)
❖ CBC: Lymphocyte↑:viral infection, AA Ret↑:hemolytic anemia(HA), ↓:AA MCV↑:MA, HA, MDS
❖ DC: blasts:leukemia, MDS, MF RBC teardrop cells, nucleated cells: MF
❖More precise to evaluate marrow cellularity hematopoietic tissue:fat=100-age:age
Diagnostic procedure
－other tests
❖ Culture ❖ CXR, PPD ❖ Auto antibodies ❖ Imaging ❖ Hepatitis testing ❖ Folic acid and VitB12 ❖ Hemolytic tests, including CD55,CD59
myeloma, lymphoma ❖ Megaloblastic anemia(MA) ❖ Paroxysmal nocturnal hemoglobinuria(PNH) ❖ Myelofibrosis(MF)
Nonhematological etiology
❖ Cirohsis hypersplenism ❖ Nonhematological malignancies:lung, GI,