医学精品课件:(参考翻译)05.2aplastic anemia-Li Wang.ppt
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1、Aplastic Anemia (再生障碍性贫血再生障碍性贫血)Wang liHaematology DepartmentThe First Affiliated HospitalReview What is the function of bone marrow 骨髓骨髓Hematopoiesis造血造血Red blood cells-transport oxygen and nutrientsWhite blood cells-fight infectionplateletshelp blood clot 凝结凝结v Bone marrow haematopoiesis failure,H
2、SC 造造血干细胞血干细胞 injuredv Peripheral blood pancytopenia 全血细胞减少全血细胞减少v Typical symptoms:anemia,infection,bleeding v Direct and indirect pathophysiologic pathways causing A.AThe main characters of Aplastic AnemiaGeneral IntroductionClassification SevereModerateAbroadAcuteChronicHomeEpidemiologyIncidence
3、China Annual incidence 7.4 per 100,000 AcuteChronic6.01.4DistributionEpidemiologyfemalemaleInfant70sChemical factors:drug (anticarcinogen 抗癌药抗癌药,chloramphenicol 氯氯霉素霉素,sulfonamide 磺胺磺胺,NSAIDs etc)chemicals (benzene 苯苯,insecticides 杀虫剂杀虫剂 etc)Physical factors radiation,X rayBiological factors viruses
4、,severe bacterium,infectionOther pathogenic factorsUnknownEtiology Pathogenesis Failure in hematopoietic stem or progenitor 祖祖 cells Defect in microenvironment of haematopoiesis Immuno-mediated 免疫介导的免疫介导的 bone marrow failure Genetic aspects:HLA associated susceptibility 敏感敏感SeedsSoilHarmful InsectsP
5、resenting symptomsAcute AAChronic AAOnsetacute,short historyslowly onset,longer historyAnemiasevere,remarkable 显著的显著的relatively moderateBleeding heavy bleeding,Multiorgan 多器官多器官Hemorrhage 出血出血 moderate,skin and mucus Infection more frequent,moderate,upper respiratory infectionSepsis 败血症败血症Laboratory
6、 findings Blood count(x109/L)granulocytes 0.5 platelets 20 reticulocytes 15 BM morphology 骨髓形态学骨髓形态学Acute AAChronic AAmultiplace hypocellularity lack of megakaryocyteslack of E,G increase in marrow fat increased non-HCSimilar findings,focal area active haematopoiesisLaboratory findings Blood count(x
7、109/L)粒细胞粒细胞 0.5 血小板血小板 20 网织红细胞网织红细胞 15 BM morphology 骨髓形态学骨髓形态学Acute AAChronic AA多种细胞减少多种细胞减少巨核细胞缺乏巨核细胞缺乏红细胞、粒细胞缺乏红细胞、粒细胞缺乏 骨髓脂肪增多骨髓脂肪增多非造血细胞增多非造血细胞增多相似表现相似表现,核心核心区域造血活跃区域造血活跃Bone marrow aspiration 吸吸Normal BM biopsyThis marrow is taken from a middle aged person,so it is about 50%cellular,with ste
8、atocytes 平衡细胞(?)平衡细胞(?)admixed 混合混合 with the marrow elements.Normal BM(high power magnification 放大放大)Note the presence of megakaryocytes,erythroid islands,and granulocytic precursors 粒细胞前体细胞粒细胞前体细胞.This marrow is taken from the posterior iliac crest 髂后上嵴髂后上嵴 in a middle aged person,so it is about 50
9、%cellular,with steatocytes admixed with the marrow elements.Aplastic anemia biopsyHematopoietic elements in this bone marrow biopsy are markedly 明显的明显的 reduced.Of course,RBC,platelets and granulocytes will often be diminished 减少的减少的.Marrow FatAplastic anemia(HP)BM morphology of Acute AABM morphology
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