Leukemoid cov tshuaj tiv thaiv - kev hloov pauv hauv hematopoiesis, zoo ib yam li cov duab ntshav hauv leukemia thiab lwm cov qog ntawm cov kab mob hematopoietic. Nws yuav tsum raug sau tseg tias qhov tshwj xeeb ntawm cov teebmeem no yog suav tias yog lawv cov kev taw qhia nquag thiab tsis muaj kev hloov pauv mus rau oncological pathology. Cov tshuaj tiv thaiv no tuaj yeem tshwm sim los ntawm ntau hom kev qaug cawv, qog nqaij hlav, kab mob, mob qog noj ntshav hauv hlwb.
Lub txheej txheem ntawm kev loj hlob tsis zoo ib yam rau ntau hom kev tawm tsam: qee zaum nws yog kev tso tawm ntawm cov cellular yam tsis paub qab hau rau hauv cov ntshav, hauv lwm tus - kev tsim cov qe ntshav ntau ntxiv lossis kev txwv ntawm kev tso tawm ntawm cell mus rau hauv cov ntaub so ntswg, los yog muaj ob peb mechanisms tib lub sij hawm.
Yuav ua li cas yog tus kab mob?
Muaj ntau yam uas tuaj yeem ua rau leukemoid tshwm sim. Cov laj thawj rau lawv txoj kev loj hlob yog:
- cuam tshuam ntawm ionizing hluav taws xob;
- tuberculosis;
- sepsis;
- txheej txheem purulent;
- mob plab;
- Ylymphogranulomatosis;
- mobpob txha taub hau;
- shock condition;
- mob ntsws ntsws;
- mug;
- scarlet fever;
- mob siab dystrophy;
- corticoid hormone kho;
- carbon monoxide lom.
kab mob
Cov kab mob leukemoid hauv qab no yog qhov txawv:
- Myeloid cov tshuaj tiv thaiv.
- Lymphocytic.
- Pseudo-regional.
Cia peb txiav txim siab txhua tus kom ntxaws ntxiv.
Myeloid
Hom no suav nrog cov tshuaj tiv thaiv xws li neutrophil, promyelocytic thiab eosinophilic. Cov teebmeem leukemoid, zoo ib yam li mob qog nqaij hlav myeloid, nrog rau kev qaug cawv thiab mob hnyav. Active leukocytosis ntawm nws cov tub ntxhais ib txwm muaj ib tug complex txheej txheem, nrog rau lub xub ntiag ntawm sepsis, inflammatory foci thiab nce nyob rau hauv lub cev kub.
Kev nthuav tawm nrog ntau dhau ntawm eosinophils hauv cov ntshav, raws li txoj cai, tshwm sim nrog kev nkag mus rau cov kab mob thiab tshuaj, kev tsis haum diathesis, tsis tshua muaj - nrog cov kab mob oncological (lymphogranulomatosis thiab lymphosarcoma). Cov tshuaj leukemoid no xav tau kev ntsuam xyuas dav dav kom tshem tawm cov kab mob ntawm cov hlab ntsha thiab cov kab mob helminths.
Reactive cells zoo li erythremia. Erythrocytosis yam feem ntau yog mob ntsws nrog kev txo qis hauv oxygenation (oxygen saturation) ntawm cov ntshav, qog nqaij hlav hauv lub raum, thiab lub plawv tsis xws luag. Hauv qhov xwm txheej no, yuav tsum tau kuaj xyuas lub computer thiab ultrasound.
Myelemia zoo ib yam li mob erythromyelosis,uas txawv tsuas yog tsis muaj blast erythrocytes nyob rau hauv cov pob txha pob txha thiab cov ntshav. Feem ntau nws tuaj yeem pom hauv pob txha metastases ntawm tus kab mob.
Lymphocytic
Cov tshuaj tiv thaiv zoo li no tau tshwm sim los ntawm kev nce ntxiv ntawm tag nrho cov lymphocytes hauv cov ntshav peripheral, uas feem ntau yog lub luag haujlwm rau kev nce hauv daim siab, cov qog ntshav qab zib thiab spleen..
hom no suav nrog mononucleosis, kis lymphocytosis, monocyte-macrophage leukemoid cov tshuaj tiv thaiv hauv cov menyuam yaus uas muaj kab mob, kis kab mob, nrog rau cov kab mob cab thiab cov ntshav loj eosinophilia (piv txwv li, nrog helminthiasis).
Lymphocytic cov tshuaj tiv thaiv tshwm sim:
- rau cov kab mob kis kab mob (kab qaib, rubella, mumps, kab mob adenovirus, qhua pias, kis kab mob mononucleosis);
- kab mob parasitic (rickettsiosis, toxoplasmosis, chlamydia);
- kab mob kab mob (syphilis, hnoos hawb pob, tuberculosis);
- ntau yam mycoses;
- kab mob autoimmune (kab mob ntshav, kab mob lupus erythematosus).
Hom lymphocytic kuj pom muaj nyob hauv Waldenström's macroglobulinemia, inflammatory txheej txheem, thiab sarcoidosis. Tag nrho cov kab mob saum toj no tau kho mob hnyav heev thiab tuaj yeem thab tus neeg mob tau ntau tshaj ib xyoos.
Pseudo-regional
Cov tshuaj leukemoid no tshwm sim yog tias tus neeg mob tab tom pib rov zoo los ntawm kev tiv thaiv kab mob agranulocytosis, qhov ua rau tuaj yeem tshwm sim los ntawm kev noj sulfonamides, Amidopyrine, Butadion thiab lwm yam tshuaj.
pab pawg ntawm cov kev cuam tshuam no yog qhov muaj nyob hauv cov ntshav peripheral thiab cov pob txha pob txha ntawm ntau cov cellular Cheebtsam nrog ib homogeneous nucleus, ib leeg nucleoli thiab xiav, nyias, tsis muaj granular cytoplasm.
Tsis zoo li cov yam ntxwv blast erythrocytes, cov no tsis muaj qhov muag muag tshwj xeeb thiab tsis tu ncua ntawm chromatin fibers. Intermittent blastoses uas ploj mus yam tsis muaj tshuaj khomob thiab muaj feem cuam tshuam rau cov teebmeem leukemoid muaj nyob rau hauv cov menyuam mos yug tshiab uas muaj cov kab mob chromosome (piv txwv li, Down syndrome).
Leukemoid cov tshuaj tiv thaiv, hom uas tau hais los saum toj no, tsim tawm tsam keeb kwm ntawm ib qho kab mob, feem ntau tsis ua rau muaj teeb meem txaus ntshai. Qee zaum thrombocytopenia tuaj yeem ua yuam kev yog ib qho ntawm cov tsos mob ntawm tus mob leukemia. Nyob rau hauv kev tshawb pom ntawm immunoblastic lymphadenitis, kev nyab xeeb ntawm cov qauv ntawm cov qog nqaij hlav, nrog rau cov kab lus tseeb ntawm cov follicles, yog qhov tseem ceeb heev.
Leukemoid cov tshuaj tiv thaiv thiab leukemia: txawv
Muaj qee qhov sib txawv ntawm cov kev kis thiab kab mob leukemia, raws li hauv qab no:
- Nrog leukemoid cov tshuaj tiv thaiv, tsis muaj kev rov ua kom cov pob txha sai sai, nws yog metamyelocytic, thiab nrog rau cov kab mob leukemia, qhov nce hauv cov ntaub ntawv tawg tau pom. Nrog rau cov teebmeem leukemoid, cov kab mob erythroid tau khaws cia, muaj qhov sib piv ntawm leukoerythroblastic - 3: 1 thiab 4: 1.
- Tsis muaj qhov pom tseeb anaplasia hauv leukemoid phenomena, ib yam li cov kab mob leukemia, thaumbulging ntawm protoplasm thiab anomaly ntawm lub nucleus tshwm sim.
- Nyob rau hauv thawj qhov sib txawv ntawm cov ntshav peripheral muaj qhov nce ntawm tus lej tseeb thiab nce feem pua ntawm cov laus neutrophils, hauv leukemia cov ntsiab lus ntawm cov laus neutrophils txo qis, thiab muaj kev loj hlob ntau dhau ntawm cov hluas, tsis paub tab. forms.
- Cov tshuaj lom neutrophil granularity yog ib txwm muaj nyob rau hauv cov tshuaj leukemoid.
- Hauv kev tshawb fawb cytochemical ntawm leukocytes hauv leukemia, muaj qhov txo qis lossis tsis muaj alkaline phosphatase, nrog cov tshuaj leukemoid - nce kev ua haujlwm.
- Eosinophilic-basophilic koom haum yog qhov ua ntej ntawm kev kub ntxhov thaum lub sij hawm exacerbation ntawm mob myeloid leukemia, tab sis nws tsis muaj nyob rau hauv cov tshuaj leukemoid.
- Nyob rau hauv myeloid leukemia, thrombocytosis siab feem ntau pom, hauv cov tshuaj leukemoid, cov platelets nyob rau hauv ib txwm muaj.
- Nyob rau hauv thawj theem ntawm mob myeloid leukemia, ib tug loj spleen tau pom, nrog leukemoid cov tshuaj tiv thaiv tej zaum kuj muaj splenomegaly, tab sis lub cev no yog mos thiab yeej tsis mus txog qhov ntau thiab tsawg.
- Thaum leukemoid tshwm sim rau cov txheej txheem neoplastic, cov qog nqaij hlav cancer tau pom hauv cov pob txha.
Leukemoid cov tshuaj tiv thaiv hauv cov menyuam yaus: kev kuaj mob algorithm
Lub luag haujlwm tseem ceeb hauv kev kuaj mob tus kab mob no tau muab rau tus kws kho mob uas kuaj xyuas cov khoom siv biopsy. Tab sis txhawm rau tiv thaiv qhov yuam kev tsis tuaj yeem, tus kws kho mob yuav tsum sau cov ntaub ntawv txhim khu kev qha txog tus neeg mob, muab nws xa mus rauntau yam kev ntsuam xyuas thiab sau ntawv kho cytostatic, uas yuav tshem tawm tag nrho cov txiaj ntsig ntawm lymphadenitis. Yog tias tag nrho cov no tsis ua tiav, ces qhov kev kuaj mob yuav raug ua tsis raug, thiab yog li ntawd nws yuav nyuaj heev los tiv thaiv tus kab mob. Tom qab tag nrho, xws li ib tug kab mob yog heev txaus ntshai. Qee zaum kev kuaj ntshav thib ob yog qhov tsim nyog rau cov ntsiab lus ntawm qhov xaus.
Qhov tseem ceeb ntawm qhov kev kuaj mob yog ib qho smear los ntawm sab nraud ntawm cov qog nqaij hlav qog nqaij hlav thiab ib qho imprint. Hauv lymphosarcoma, feem ntau ntawm cov qe ntshav liab (tsawg kawg 30 feem pua) yog cov hlwb tawg mus tas li. Hauv immunoblastic lymphadenitis, cov RBCs no feem ntau tsawg dua 10 feem pua thiab sib txawv ntawm cov cytoplasmic basophilia thiab kev loj hlob ntawm nuclear.
Kev kuaj mob raws li kev soj ntsuam ntawm cov qog ntshav qab zib yuav tsum tau nthuav dav heev thiab tsis suav nrog cov lus xaus tsis raug. Vim hais tias tus kws kho mob pathohistologist rau ntau yam kev kuaj ntshav yuav tsum qhia meej txog qhov kev kuaj mob, thiab qhov no tau tshwm sim hauv qhov xaus. Piv txwv li, txhawm rau txhim kho thawj qhov kev kuaj mob ntawm benign lymphomas, qee zaum, nws yuav tsum tau soj ntsuam tus neeg mob kom ntev thiab tshuaj xyuas cov qog ntshav qab zib.
Kev kuaj mob ntawm leukemoid cov tshuaj tiv thaiv, xav tias los ntawm kev kuaj pom ntawm monoclonal immunoglobulin, qee zaum xav tau ntau xyoo ntawm kev soj ntsuam thiab rov ua cov pob txha pob txha. Txog thaum kuaj pom tseeb, kev kho mob qog noj ntshav yog contraindicated.
kis kab mob mononucleosis
Kuj hu ua kab mob Filatov-Pfeifer, ua npaws qog thiab mob qog noj ntshav. YogCov kab mob kis tau tshwm sim los ntawm kev hloov pauv ntawm cov lymphocytes, nthuav cov qog ntshav thiab spleen, reactive lymphadenitis, cov tsos ntawm cov erythrocytes tshwj xeeb hauv cov ntshav peripheral. Tus neeg sawv cev ua rau yog tus kab mob Epstein-Barr. Lub hauv paus ntawm tus kab mob yog lub moj tej tawg transformation ntawm lymphocytes los ntawm ib tug tshwj xeeb kis kab mob.
Qhov chaw kho mob txawv. Hauv cov ntawv me me, kev noj qab haus huv raug cuam tshuam vim rhinitis. Cov cim qhia:
- angina ("burning pharynx");
- nthuav dav ntawm tus po thiab lub ncauj tsev menyuam qog noj ntshav, nrog rau lawv qhov mob;
- ua pa nyuaj rau thawj hnub ntawm tus kab mob vim qhov o ntawm cov mucous o.
Ntshav: nce feem pua ntawm eosinophils, lymphocytes thiab monocytes.
Kev nyuaj siab
Ib qho tsim nyog thiab txaus qhia ntawm tus kab mob rau qhov xaus yog qhov muaj nyob hauv cov ntshav ntawm peculiar mononuclear hlwb (tshaj 10-20%) - cov hlwb sib txawv hauv cov nucleus ntawm cov lymphocyte loj thiab dav basophilic lilac- xim cytoplasm nrog pronounced perinuclear enlightenment. Leukemoid cov tshuaj tiv thaiv nyob rau ob peb lub lis piam hauv cov menyuam yaus thiab cov neeg laus, tab sis nyob rau qee lub sijhawm, kev ua haujlwm ntawm cov ntshav hauv lub xeev yuav siv sij hawm ntau lub hlis.
Kev rov qab los kuj tau pom nrog cov chav kawm me me, qee zaum ntawm ob peb xyoos tom qab thawj lub sijhawm mob. Cov teeb meem tuaj yeem yog:
- mob siab mob siab;
- ncephalitis;
- agranulocytosis;
- tawg ntawm tus po vim nws loj zuj zus;
- autoimmunehemolysis.
Kev kho rau cov kab mob leukemoid
Raws li txoj cai, cov neeg mob tsis tas yuav kho tshuaj tshwj xeeb, vim tias nyob rau ob peb hnub cov cim tseem ceeb ntawm tus kab mob ploj mus thiab cov ntshav rov zoo li qub. Nrog rau kev mob ntev thiab kev noj qab haus huv ntawm tus neeg mob tsis zoo, kev kho mob pathogenetic yog siv - Prednisolone tau muab tshuaj ntawm 20-30 milligrams ib hnub lossis lwm yam tshuaj glucocorticoid txhawm rau tshem tawm cov tshuaj leukemoid. Txawm li cas los xij, tsuas yog ib tus kws kho mob tshwj xeeb xwb.
Huab cua
Feem ntau qhov zoo: kev sib kis tsawg thiab yog li ntawd tsis tsim nyog rau kev cais tus neeg mob. Txawm li cas los xij, ruptures ntawm tus po yog qhov txaus ntshai heev. Kev rov ua haujlwm ntawm lub peev xwm yog txiav txim siab los ntawm qhov pom ntawm cov cim qhia ntawm kev txo qis hauv lub cev, nrog rau kev ploj ntawm tonsillitis thiab normalization ntawm lub cev kub. Yog tias kis kab mob mononucleosis tshwm sim nws tus kheej hauv daim ntawv ntawm kab mob siab, yuav tsum tau mus pw hauv tsev kho mob ntawm tus neeg mob.
