Raws li koj paub, cov ntaub so ntswg ntawm lub cev tuaj yeem raug hloov pauv tsis zoo. Hematopoietic system yog tsis muaj kev zam. Cov kab mob ntawm cov ntaub so ntswg no tau muab faib ua 2 pawg: myelo- thiab lymphoproliferative neoplastic txheej txheem. Pathology ntawm cov ntaub so ntswg hematopoietic hu ua hemoblastosis. Qhov no yog lub npe dav dav rau txhua yam ntawm cov txheej txheem neoplastic. Feem ntau, hemoblastoses tshwm sim thaum yau. Txawm li cas los xij, qee cov qog ntshav ntshav tshwm sim tshwj xeeb rau cov neeg laus. Hematologist cuam tshuam nrog cov ntshav pathologies. Nws paub txog hom hemoblastosis thiab sau cov kev kho mob uas tsim nyog. Txoj kev tseem ceeb ntawm normalizing ntshav muaj pes tsawg leeg yog chemotherapy.
Hemoblastosis - yog dab tsi?
Zoo li txhua yam kab mob oncological, hemoblastoses yog tus cwj pwm los ntawm qhov tsos thiab kev tsim tawm ntawm cov hlwb tsis paub qab hau. Cov no yuav yog cov ntsiab lus tsis txawv ntawm hematopoietic lossis lub cev tiv thaiv kab mob. Nyob rau hauv thawj rooj plaub, tus txheej txheem yog myeloproliferative nyob rau hauv cov xwm thiabhu ua leukemia. Kev tsim tawm ntawm cov hlwb tsis paub qab hau yog xa los ntawm qee tus kws sau ntawv mus rau lymphomas, lwm tus mus rau hematosarcomas. Yav dhau los, cov qog ntshav ntshav no hu ua leukemia.
Hmoov tsis zoo, hemoblastosis yog ib qho ntawm cov laj thawj tseem ceeb ntawm cov neeg tuag los ntawm cov qog nqaij hlav cancer. Nyob rau hauv cov qauv oncological, ntshav pathologies nyob ntawm 5th-6th qhov chaw. Cov qog no tshwj xeeb tshaj yog nyob rau hauv cov me nyuam preschool. Cov txheej txheem tseem ceeb rau tus kab mob muaj xws li: intoxication, hemorrhagic, hyperplastic thiab anemic syndrome. Tsuas yog tom qab kuaj ntshav zoo tuaj yeem kuaj xyuas hemoblastosis. Ib tus lej ICD-10 tau muab rau txhua hom kab mob leukemia.
Ua rau kev txhim kho cov kab mob ntawm cov kab mob hematopoietic
Ntshav qog nqaij hlav, zoo li lwm yam neoplasms, feem ntau tshwm sim sai sai, tsis muaj cov cim yav dhau los. Yog li ntawd, nws muaj peev xwm paub txog qhov ua rau ntawm cell transformation nyob rau hauv tsawg zaus. Txawm li cas los xij, nws tau raug pov thawj tias kev loj hlob ntawm leukemia tuaj yeem cuam tshuam nrog qhov ua rau muaj qhov tshwm sim ua ntej leukemia ntev ua ntej nws pib. Cov laj thawj xws li hluav taws xob. Kab mob ntshav (hemoblastosis) feem ntau tshwm sim tom qab hluav taws xob raug rau lub cev. Yog li ntawd, etiological yam tseem ceeb muaj xws li ionizing thiab ultraviolet hluav taws xob, nrog rau cov txheej txheem kuaj mob thiab kho rau lwm cov qog. Ntawm lwm cov laj thawj rau kev loj hlob ntawm hemoblastoses, muaj:
- Viral impact.
- Congenital genetic anomalies.
- Txoj kev ua txhaum caiCov amino acids.
- raug tshuaj lom neeg carcinogens.
Tus kab mob Epstein-Barr pom nyob rau hauv qee cov neeg mob uas mob qog nqaij hlav qog ntshav thiab hemoblastoses. Cov kab mob no tsis tsuas yog ua rau lub cev tsis muaj zog, tab sis kuj ua rau cov oncogenes tam sim no hauv lub cev. Lub luag haujlwm ntawm cov kab mob retroviruses hauv kev tsim tawm ntawm tes kuj tseem raug kawm. Ntawm cov kab mob caj ces, muaj feem yuav muaj xws li: Klinefelter syndrome, Down syndrome, Louis Bar. Chromosomal abnormalities thiab congenital metabolic disorders ua rau impaired sib txawv ntawm myeloid thiab lymphoid hlwb.
Tshuaj carcinogens suav nrog qee cov tshuaj tua kab mob thiab cytotoxic. Piv txwv yog cov tshuaj hauv qab no: Chloramphenicol, Levomycetin, Azathioprine, Cyclophosphamide, thiab lwm yam. Yog li ntawd, kev pheej hmoo ntawm leukemia yog nce rau cov neeg tau txais kev kho mob rau cov qog nqaij hlav malignant neoplasms. Tseem muaj cov kab mob carcinogens ntawm cov lag luam uas siv benzene thiab lwm yam tshuaj phem.
Mechanism of development of leukemia
Lub pathogenesis ntawm tag nrho cov kab mob oncological yog raws li kev ua txhaum ntawm kev sib txawv ntawm cov cellular ntsiab. Hemoblastosis yog ib hom kab mob uas tsis paub tab myelo- thiab lymphocytes tshwm hauv cov ntshav. Impaired differentiation tuaj yeem tshwm sim ntawm txhua theem ntawm kev loj hlob ntawm progenitor cell. Qhov ua ntej qhov teeb meem tshwm sim, tus kab mob malignant ntau dua. Nws ntseeg tau tias nyob rau hauv kev cuam tshuam ntawm etiological yam, kev hloov pauv tshwm sim hauv cov noob. Qhov no ua rau muaj kev hloov pauv hauv qhov zoo ntawm cov chromosomes thiab lawv cov kev hloov kho tshiab.
Txhua tushemoblastoses (leukemias) yog cov keeb kwm monoclonal. Qhov no txhais tau hais tias tag nrho cov kab mob pathological hauv cov ntshav yog tib yam hauv cov qauv. Ib txwm sib txawv ntawm cov qe ntshav mus dhau ntau theem. Lub precursor ntawm tag nrho cov ntaub so ntswg ntsiab yog qia cell. Thaum nws loj tuaj, nws ua rau myelo- thiab lymphoblasts. Cov qub tau hloov mus rau hauv cov qe ntshav liab thiab platelets. Pab pawg thib ob ntawm cov hlwb ua rau cov ntsiab lus ntawm lub cev tiv thaiv kab mob ntawm cov ntshav, uas yog, leukocytes.
Txoj kev sib txawv ntawm cov qia hlwb ua rau qhov tseeb tias cov ntshav muaj pes tsawg leeg tau hloov pauv tag nrho. Nyob rau hauv txoj kev tshawb no nws yog tsis yooj yim sua los txiav txim ib tug ib txwm lub caij. Tag nrho cov ntawm lawv yog tib yam, yog li lawv tsis tuaj yeem ua cov haujlwm tsim nyog. Qhov no piav qhia qhov tseeb tias tsis muaj qhov sib txawv ntawm hemoblastosis yog suav tias yog mob qog noj ntshav siab tshaj plaws thiab muaj qhov tshwm sim tsis zoo. Yog hais tias maturation yog cuam tshuam nyob rau hauv cov theem tom qab, lub hlwb ib feem los yog tag nrho ua hauj lwm. Yog li ntawd, kev kwv yees rau kev mob qog noj ntshav sib txawv yog qhov zoo dua. Txawm li cas los xij, txawm tias tag nrho cov hlwb uas paub tab txawv hauv kev faib cov kab mob thiab tshem tawm lwm cov ntshav ib txwm muaj.
Ntau hom hemoblastoses hauv cov neeg laus thiab menyuam yaus
Muab cov kab mob ntawm hemoblastosis, tus kab mob feem ntau yog cais raws li qib ntawm kev sib txawv ntawm cov kab mob ntawm tes. Tsis tsuas yog daim duab kho mob ntawm tus kab mob nyob ntawm qhov no, tab sis kuj yog kev xaiv ntawm kev kho kom raug. Nyob ntawm seb hom cell twg tau hloov pauv, myelo- thiab lymphoproliferative hemoblastosis raug cais. Txhua pab pawg no tau muab faib ua mob hnyav thiabmob leukemia. Thawj yog suav tias yog qhov tsis zoo dua vim qhov qis ntawm qhov sib txawv. Txhawm rau kuaj pom tus mob leukemia, nws yog ib qho tsim nyog yuav tsum paub meej tias muaj cov blast cells. Hauv hom myeloid, precursors ntawm monocytes, megakaryocytes, thiab erythrocytes tuaj yeem yog cov kab mob sib kis. Mob lymphoid hemoblastosis yog ib yam kab mob loj uas tshwm sim thaum yau. Nyob rau hauv cov ntaub ntawv no, lub cev tiv thaiv kab mob muaj cov kev ua ntawm pathology. Ntawm lawv yog cov precursors ntawm B- thiab T-lymphocytes, nrog rau antigens CD-10 thiab CD-34.
Cov hemoblastoses ntev kuj tseem faib ua myeloid thiab lymphoid. Cov qub yog tus cwj pwm los ntawm kev nce ntawm cov neutrophils, basophils, eosinophils lossis lawv cov neeg paub tab ua ntej. Tus naj npawb ntawm cov blast hlwb nyob rau hauv cov mob myeloid leukemia yog me me. Feem ntau, tus kab mob no tshwm sim tawm tsam keeb kwm ntawm kev hloov caj ces. Mob lymphocytic leukemia feem ntau pom nyob rau hauv cov neeg laus cov txiv neej. Qee zaum cov kab mob pathology tau tshwm sim. Ib qho mob zoo sib xws tau muab faib ua pawg hauv qab no:
- T-cell leukemia.
- YParaproteinemic hemoblastoses.
- B-cell leukemias.
Tag nrho cov npe pathologies muaj feem xyuam rau cov txheej txheem malignant immunoproliferative. Paraproteinemic hemoblastoses, nyob rau hauv lem, muab faib ua cov hauv qab no:
- Heavy chain disease.
- Thawj Waldenström macroglobulinemia.
- Myeloma.
Qhov peculiarity ntawm no ntau yam ntawm hemoblastoses yog qhov ntawdNyob rau hauv lawv cov fragments ntawm immunoglobulins (paraproteins) yog synthesized. Feem ntau hom kab mob leukemias no yog myeloma.
Daim duab kho mob hauv cov ntshav tsis tu ncua
hemoblastosis tshwm sim nws tus kheej li cas? Cov tsos mob ntawm cov kab mob lymphoproliferative ntshav yog txuam nrog kev tiv thaiv kab mob. Cov neeg mob uas muaj kab mob leukemia tsis txaus ntseeg ntawm cov kab mob uas tshwm sim txawm tias kho. Tsis tas li, cov tsos mob ntawm lymphoid hemoblastosis muaj xws li kev tsis haum tshuaj hnyav uas tsis tau pom yav dhau los. Qhov no yog vim qhov kev txhim kho ntawm lub cev tiv thaiv kab mob thiab nws txoj kev ua kom ntau dhau. Daim duab kho mob ntawm tus mob myeloid leukemia nyob ntawm theem ntawm tus kab mob. Nyob rau hauv thawj theem, tus kab mob zoo li ib tug inflammatory txheej txheem thiab yog nrog los ntawm ib tug tsawg kub, deterioration ntawm kev noj qab haus huv, thiab tsis muaj zog. Nyob rau hauv lub davhlau ya nyob twg, cov tsos mob tau sau npe koom nrog: mob pob txha, lymphadenopathy, nce qhov loj ntawm tus po thiab daim siab. Nrog kev vam meej, cov neeg mob tsis noj zaub mov hnyav, poob phaus tshwm sim, kis kab mob koom nrog.
Vim qhov tseem ceeb ntawm qee hom hlwb hauv cov ntshav, kev loj hlob ntawm lwm cov ntsiab lus yog inhibited. Yog li ntawd, anemia thiab thrombocytopenia yuav tshwm sim. Kev txo qis hauv qib hemoglobin cuam tshuam rau cov xwm txheej ntawm tus neeg mob. Tus neeg mob ua kom qaug zog, daim tawv nqaij daj ntseg, muaj qhov txo qis hauv ntshav siab, fainting yog sau tseg. Nrog thrombocytopenia, hemorrhagic syndrome tshwm sim. Nws tshwm sim muaj ntau yam los ntshav.
Symptoms of acuteleukemia
Piv rau daim ntawv mob ntev ntawm tus kab mob, mob hemoblastosis tau hais ntau dua. Cov tsos mob ntawm tus kab mob no tau loj hlob sai, thiab tus neeg mob tau pom tias tsis zoo lawm. Cov tsos mob hauv qab no muaj nyob hauv daim duab kho mob:
- Nyob zoo ib tsoom phooj ywg.
- Hemorrhagic.
- YLymphoproliferative.
- YHepatosplenomegaly Syndrome.
- Kev mob siab.
- Immune System Damage Syndrome.
Vim qhov inhibition ntawm hematopoiesis, cov neeg mob muaj ntshav qab zib hnyav. Qhov no yog tshwj xeeb tshaj yog nyob rau hauv lymphoid leukemia. Txawm hais tias kev kho tsis tu ncua, hemoglobin hauv cov neeg mob tseem qis. Cov tsos mob ntawm tus kab mob anemia muaj xws li pallor, qaug zog heev, tawv nqaij qhuav, puas rau cov mucous daim nyias nyias, thiab saj perversion. Hemorrhagic syndrome yog tus cwj pwm los ntawm cov tsos ntawm cov liab dots thiab pob ntawm daim tawv nqaij (petechiae, ecchymosis). Nrog rau qhov tsis muaj cov platelets, cov ntshav tawm sab nraud thiab sab hauv tshwm sim, uas ua rau muaj kev mob ntshav qab zib.
Intoxication hauv cov neeg mob uas muaj hemoblastoses tshwm sim los ntawm kev txo qis hauv qab los noj mov, mob hauv cov leeg thiab pob txha, thiab tsis muaj zog tas li. Zoo li txhua yam txheej txheem oncological, ntshav qog noj ntshav yog nrog los ntawm kev poob phaus. Mob hemoblastosis yuav luag ib txwm nrog lymphadenopathy. Los ntawm qhov nce ntawm qhov loj ntawm thymus, ua pa tsis ua haujlwm tuaj yeem txhim kho. Ntxiv nrog rau hypertrophy ntawm txhua pawg ntawm cov qog ntshav, hepato- thiab splenomegaly tau sau tseg. Daim duab kho mob ntawm hemoblastosis hauv menyuam yaus yog tib yam li cov neeg laus.
Kev mob qog noj ntshav ua raukev puas tsuaj rau yuav luag txhua lub cev thiab lub cev. Ua ntej tshaj plaws, cov noob qes thiab ob lub raum raug cuam tshuam. Qhov teeb meem tseem ceeb ntawm tus kab mob yog DIC, uas yog, ua txhaum ntawm cov ntshav txhaws. Tsis tas li, cov neeg mob feem ntau raug kev txom nyem los ntawm kev koom nrog kev kis kab mob uas tawm tsam keeb kwm ntawm kev tiv thaiv kab mob.
Txoj kev kuaj mob hemoblastoses
mob hemoblastoses muaj cov txheej txheem kuaj mob hauv qab no: qhov txo qis hauv hemoglobin nrog cov xim ib txwm muaj, neutropenia, thrombocytopenia thiab lymphocytosis hauv CBC. Tus naj npawb ntawm leukocytes txawv nyob ntawm seb hom kab mob. Nrog hemoblastoses ntawm hom lymphoid, lawv qib nce sharply (tsawg thiab ntau pua zaus). Kev txo qis ntawm cov leukocytes tuaj yeem pom nrog myeloproliferative ntshav qog noj ntshav. Qhov kev kuaj mob tseem ceeb rau cov txheej txheem mob hnyav yog qhov muaj cov hlwb tawg thiab tsis muaj cov ntsiab lus nruab nrab. Ib daim duab zoo sib xws ntawm cov ntshav yog hu ua leukemic tsis ua haujlwm. Txhawm rau paub meej qhov kev kuaj mob, kuaj pob txha pob txha thiab kuaj rau myeloperoxidase, chloroacetate esterase, thiab PAS tau ua.
Cov kev kuaj mob ntxiv muaj xws li: hauv siab x-ray, cytogenetic tsom xam, ultrasound ntawm cov ntaub so ntswg thiab cov kab mob hauv nruab nrog cev. Kev tshawb fawb algorithm rau kev xav tias mob hemoblastoses yog tib yam. Hauv KLA, muaj kev hloov pauv hauv leukoformula rau cov ntshav nruab nrab (promyelocytes). Blast cells tej zaum yuav muaj nyob rau hauv me me. Nyob rau hauv mob myeloid leukemia, Philadelphia chromosome tshwm nyob rau hauv cov pob txha pob txha. Kev kuaj serological thiab ELISA pab kom paub meej tias cov qog ntshav qog ntshav qog ntshav.
Hemoblastoses: kev kuaj mob sib txawv ntawm cov kab mob
Rau lub hauv paus ntawm cov ntaub ntawv kho mob nkaus xwb, nws nyuaj rau kev kuaj mob: hemoblastosis. Tom qab tag nrho, qhov tshwm sim ntawm tus kab mob no zoo ib yam li lwm yam kab mob pathological. Raws li qhov tseem ceeb ntawm ib qho kev mob tshwm sim, leukemia txawv ntawm Hodgkin tus kab mob, aplastic thiab hemolytic anemia, kab mob HIV. Yog tias ua pa tsis ua haujlwm ua ntej, tus kab mob zoo ib yam li cov qog ntawm mediastinum lossis lub ntsws. Tsuas yog tom qab kev tshawb fawb txog ntshav thiab pob txha pob txha tuaj yeem ua rau hemoblastosis txawv ntawm cov kab mob uas tau teev tseg.
Kev kho mob qog noj ntshav thiab mob ntev
Hemoblastosis kuaj tau li cas? ICD-10 code yog txawv rau txhua hom kab mob leukemia. Tus mob myeloid neoplasm ntawm cov ntshav tau muab rau tus lej C92.0, cov txheej txheem mob ntev - C92.1. Lymphoproliferative leukemias yog coded li C91.0-C91.9. Nyob ntawm qhov kev kuaj mob, xaiv txoj kev kho mob. Txoj kev tseem ceeb yog chemotherapy. Rau kev kho mob, cov tshuaj "Vincristine", "Endoxan", "Doxylid", "Cytarabine" yog siv. Kev xaiv ntawm cov tshuaj nyob ntawm seb hom hemoblastosis. Qee cov tswv yim suav nrog cov tshuaj hormonal "Prednisolone". Kev kho mob yog tsom rau induction thiab consolidation (consolidation) ntawm kev zam txim. Tom qab ntawd sau tshuaj rau kev kho mob. Ntawm lawv yog cov tshuaj Mercaptopurine thiab Methotrexate.
Ntxiv rau kev kho tshuaj, kev kho hluav taws xob thiab kev hloov cov pob txha pob txha. Qee zaum, kev phais mob splenectomy tau ua.
Hemoblastoses: kev tiv thaiv thiab kev soj ntsuam
Nws tsis tuaj yeem kwv yees kev loj hlob ntawm leukemia ua ntej, yog li tsis muaj txoj hauv kev tshwj xeeb ntawm kev tiv thaiv. Cov neeg uas muaj lub nra hnyav ntawm keeb kwm oncological yuav tsum tiv thaiv lawv tus kheej los ntawm ntau yam hluav taws xob thiab tshuaj lom neeg.
Nws yuav tsum nco ntsoov tias qee hom kab mob leukemia feem ntau yog los ntawm keeb kwm. Yog li ntawd, nyob rau hauv muaj cov ntshav qog ntshav hauv cov txheeb ze, nws yog ib qho tsim nyog tsis yog tsuas yog coj txoj kev noj qab haus huv xwb, tab sis kuj coj OAC ib ntus. Ib qho piv txwv yog paraproteinemic hemoblastosis. Cov tsos mob ntawm tus kab mob yog nyob ntawm seb qhov sib txawv ntawm cov qog hlwb thiab kev kho mob raws sij hawm. Qhov kev muaj sia nyob tsib xyoos yog 30 txog 70 feem pua nrog kev tshem tawm thiab hloov cov pob txha pob txha.
