Li Jia, Zhang Man
Capital Medical University, Beijing, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2013 Jun;21(3):657-61. doi: 10.7534/j.issn.1009-2137.2013.03.024.
This study was purpose to investigate the diagnostic value of hematopoietic cell dysplasia in myelodysplastic syndrome (MDS). Sixty-four cases of WHO-MDS were detected by cytomorphology, cytohistochemical staining and bone marrow biopsy. The characteristics of hematopoietic cell dysplasia were analyzed, and its sensitivity and specificity were evaluated for WHO-MDS diagnosis. The results showed that though myeloblast, megakaryocytes presented in peripheral blood and granular Auer body, abnormal granular pseudo Pelger-Huër, vacuole of erythroid, micro-megakaryocytes appeared in bone marrow for diagnosis sensitivity were not very high, and respectively were 34.4%, 3.1%, 3.1%, 75.0%, 6.3%, 42.4%, the specificity of these characteristics was 100%. Moreover, erythroid odd nucleus, nuclear deformity, fragmentation, nuclear budding, ring sideroblasts, single and more round nuclear megakaryocyte had better reference value for WHO-MDS diagnosis. By bone marrow biopsy, the dysplasia and abnormal localization of immature precursor (ALIP) also were found in patients with WHO-MDS. More than half patients with WHO-MDS had mild to moderate increase in reticulin fibres. It is concluded that the cytomorphology assay is the base and key for the diagnosis of WHO-MDS. Diagnostic accuracy can be improved by combinative use of a variety of detection methods.
本研究旨在探讨造血细胞发育异常在骨髓增生异常综合征（MDS）中的诊断价值。对64例世界卫生组织（WHO）分型的MDS患者进行了细胞形态学、细胞组织化学染色及骨髓活检检测。分析造血细胞发育异常的特征，并评估其对WHO-MDS诊断的敏感性和特异性。结果显示，外周血中的原始粒细胞、巨核细胞以及骨髓中的颗粒状奥氏小体、异常颗粒状假佩尔格-许埃畸形、红系空泡、微小巨核细胞等用于诊断的敏感性不高，分别为34.4%、3.1%、3.1%、75.0%、6.3%、42.4%，这些特征的特异性为100%。此外，红系奇形核、核畸形、核碎裂、核出芽、环形铁粒幼细胞、单个及多个圆形核巨核细胞对WHO-MDS诊断有较好的参考价值。通过骨髓活检，还发现WHO-MDS患者存在发育异常及幼稚前体细胞异常定位（ALIP）。超过半数的WHO-MDS患者网硬蛋白纤维有轻度至中度增加。结论是，细胞形态学检测是WHO-MDS诊断的基础和关键。联合使用多种检测方法可提高诊断准确性。
