Harris V N, Malysz J, Smith M D
William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
J Clin Pathol. 2009 Sep;62(9):853-4. doi: 10.1136/jcp.2009.064766.
Acute hepatic failure is traditionally diagnosed on the basis of clinical presentation, historical information, and a collection of abnormal laboratory findings including elevated aspartate aminotransferase, alanine aminotransferase, prothrombin time, serum bilirubin and alpha-fetoprotein. Non-specific haematological findings such as anaemia, thrombocytopenia and changes in erythrocyte morphology are well documented in patients with liver failure. It is believed, however, that there are no specific morphological findings on peripheral blood smears directly linked to liver failure. This report describes two patients diagnosed with acute hepatic failure, both having coarse, bright-green cytoplasmic inclusions identified within their neutrophils. One previous case of a patient with similar neutrophil findings and concurrent liver disease has been reported in the literature; however, a direct relationship to liver failure was not proposed. It is suggested that the findings may be directly related to liver failure and may also serve as a prognostic indicator of impending death.
传统上，急性肝衰竭是根据临床表现、病史信息以及一系列异常实验室检查结果来诊断的，这些结果包括天冬氨酸转氨酶、丙氨酸转氨酶、凝血酶原时间、血清胆红素和甲胎蛋白升高。肝功能衰竭患者中，贫血、血小板减少和红细胞形态改变等非特异性血液学表现已有充分记录。然而，人们认为外周血涂片上没有与肝衰竭直接相关的特异性形态学表现。本报告描述了两名被诊断为急性肝衰竭的患者，他们的中性粒细胞内均发现有粗大的亮绿色胞质内含物。文献中曾报道过一例有类似中性粒细胞表现且并发肝病的患者；然而，并未提出其与肝衰竭有直接关系。有人认为，这些表现可能与肝衰竭直接相关，也可能作为即将死亡的预后指标。
