Raanani P, Levi I, Holzman F, Grotto I, Brok-Simoni F, Avigdor A, Davidson J, Shpilberg O, Ben-Bassat I
Institute of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Bone Marrow Transplant. 2001 Feb;27(3):311-7. doi: 10.1038/sj.bmt.1702761.
Hypophosphatemia associated with bone marrow transplantation has been infrequently reported. The suggested mechanism is phosphate uptake by the replicating cells. Various cytokines are associated with the development of hypophosphatemia. The present study evaluated the interrelationship between cytokine release, the rise in WBC and the development of hypophosphatemia during the engraftment period. Blood samples were obtained from 60 patients undergoing peripheral blood stem cell transplant, on the day of admission and then daily from the day of transplant until discharge. Hypophosphatemia developed in 62% of the patients. The median day of minimal phosphorus level was +8 and it antedated engraftment by 2 days. There was a significant correlation between the day of minimal phosphorus level and the day of maximal WBC and a significant correlation between the fall in phosphorus level and WBC rise. IL-6 and IL-8 showed similar kinetics. Higher IL-6 and IL-8 levels were directly associated with lower phosphorus levels. In conclusion, hypophosphatemia commonly occurs in the post-transplant period. We assume that both a direct effect of cytokine release and an increased consumption by the dividing WBCs contribute to its appearance. As its occurrence usually antedates engraftment it can be used as a forerunner for WBC recovery.
与骨髓移植相关的低磷血症鲜有报道。推测其机制为复制细胞摄取磷酸盐。多种细胞因子与低磷血症的发生有关。本研究评估了移植期细胞因子释放、白细胞升高与低磷血症发生之间的相互关系。对60例接受外周血干细胞移植的患者，于入院当天采血，然后自移植日起每日采血直至出院。62%的患者发生了低磷血症。最低磷水平的中位时间为移植后第8天，且比植入提前2天。最低磷水平的日期与白细胞最高值的日期之间存在显著相关性，磷水平下降与白细胞升高之间也存在显著相关性。白细胞介素-6（IL-6）和白细胞介素-8（IL-8）表现出相似的动力学。较高的IL-6和IL-8水平与较低的磷水平直接相关。总之，低磷血症在移植后时期常见。我们认为细胞因子释放的直接作用和分裂的白细胞消耗增加均促成了其出现。由于其发生通常早于植入，故可作为白细胞恢复的先兆。
