Reenesh Mechery, Munishwar Singh, Rath Saroj Kumar
Division of Periodontology, Armed Forces Medical College Pune India.
Department of Dental Surgery, Armed Forces Medical College Pune India.
J Oral Maxillofac Res. 2012 Oct 1;3(3):e5. doi: 10.5037/jomr.2012.3305. eCollection 2012.
Acute myeloblastic leukaemia is a malignant bone marrow neoplasm of myeloid precursors of white blood cells. Due to its high morbidity rate, early diagnosis and appropriate medical therapy is essential.
The article highlights normal blood alterations like anaemia, thrombocytopenia, leukocytosis and advanced diagnostic aids like flow cytometry, special staining as a diagnostic modality as well as for prognostic information in acute leukaemia, particularly as a tool for assigning lineage and facilitating further pathologic classification which may be helpful in influencing treatment strategies.
On clinical examination the case presented with features of inflammatory gingival enlargement with presence of local deposits and calculus. Routine blood examination anaemia, thrombocytopenia, leukocytosis with haemoglobin 5.6 gm% and total leukocyte count of 1,12,000 / cu mm suggestive of leukaemia. Myeloperoxidase and leukocyte nonspecific esterase (NSE) special stain were used which showed presence of myeloblasts in the peripheral smear suggestive of acute myelocytic leukaemia. Flow cytometry were done which further helped in interpretation of these cells which showed to be strongly positive for CD45, CD13, CD14, and anti HLADR and moderately positive for CD4, CD34 and Anti MPO confirming to be case of AML-M4 with 57.73% gating.
Fact that gingival alterations are sometimes the first manifestations of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of systemic diseases. The timely referral by the general dentist for a suspicious lesion provided an early diagnosis and early intervention reducing the patient morbidity.
急性髓细胞白血病是一种白细胞髓系前体细胞的恶性骨髓肿瘤。由于其发病率高，早期诊断和适当的医学治疗至关重要。
本文重点介绍了贫血、血小板减少、白细胞增多等正常血液变化，以及流式细胞术、特殊染色等先进诊断辅助手段，这些手段作为诊断方式以及急性白血病预后信息的工具，特别是作为确定细胞系和促进进一步病理分类的工具，这可能有助于影响治疗策略。
临床检查发现该病例有炎症性牙龈肿大，伴有局部沉积物和牙结石。常规血液检查显示贫血、血小板减少、白细胞增多，血红蛋白为5.6克%，白细胞总数为112,000/立方毫米，提示白血病。使用了髓过氧化物酶和白细胞非特异性酯酶（NSE）特殊染色，外周血涂片显示有原始粒细胞，提示急性髓细胞白血病。进行了流式细胞术检测，进一步有助于对这些细胞进行解读，结果显示这些细胞对CD45、CD13、CD14和抗HLADR呈强阳性，对CD4、CD34和抗MPO呈中度阳性，证实为AML-M4病例，门控率为57.73%。
牙龈改变有时是该疾病的首发表现，这一事实意味着牙科专业人员必须充分熟悉全身性疾病的临床表现。普通牙医对可疑病变的及时转诊提供了早期诊断和早期干预，降低了患者的发病率。
