Hast R, Nilsson I, Widell S, Ost A
Department of Medicine, Dander yd Hospital, Stockholm, Sweden.
Leuk Res. 1989;13(2):173-8. doi: 10.1016/0145-2126(89)90142-2.
Dysplastic features of peripheral blood granulocytes were studied to investigate the diagnostic value estimating cytoplasmatic hypogranulation and nuclear abnormalities of the pelgeroid type in myelodysplastic syndromes (MDS). Hypogranulation was measure both as the percentage of agranular neutrophils and as a score value, taking into account also cells with slight or moderate hypogranulation. We studied 62 cases of MDS (18 refractory anemia, 11 sideroblastic anemia, 26 refractory anemia with excess of blasts, three chronic myelomonocytic leukemias, four refractory anemia with excess of blasts in transformation). For comparison we studied 13 cases of myeloproliferative disorders, 18 patients with different forms of anemia and 20 normal controls. Reference values were defined as the 95% probability limit of the mean values of normal controls. In MDS 52/62 patients (84%) had increased numbers of pelgeroid cells, 40/62 (65%) had abnormal granulation scores while only 14/62 (23%) had increased percentages of agranular neutrophils. The mean granulation score (+/- S.D.) in MDS (225.0 +/- 57.4), was significantly lower (p less than 0.001) than in myeloproliferative disorders (282.7 +/- 9.0), anemias (288.8 +/- 8.0) and normal controls (281.7 +/- 12.9). Pelgeroid neutrophils were significantly (p less than 0.001) more common in MDS (11.6% +/- 7.8) compared to myeloproliferative disorders (1.1% +/- 1.0), anemias (3.1% +/- 2.0) and normal controls (1.9% +/- 1.5). There was no significant correlation between the degree of hypogranulation and the percentages of pelgeroid cells in individual patients. Hypogranulation tended to be more pronounced in the more immature forms of MDS while pelgeroid cells were equally common in the different subgroups. When the two parameters were combined peripheral blood dysplasia was recognized in 92% of the MDS cases. The results suggest that quantitative estimation of hypogranulation and of nuclear abnormalities in peripheral blood polymorphs are simple and valuable diagnostic tools in MDS.
研究外周血粒细胞的发育异常特征，以探讨评估骨髓增生异常综合征（MDS）中细胞质颗粒减少和类Pelger样核异常的诊断价值。颗粒减少通过无颗粒中性粒细胞的百分比以及评分值来衡量，同时也考虑轻度或中度颗粒减少的细胞。我们研究了62例MDS患者（18例难治性贫血，11例环形铁粒幼细胞性贫血，26例伴有原始细胞增多的难治性贫血，3例慢性粒-单核细胞白血病，4例转化中的伴有原始细胞增多的难治性贫血）。作为对照，我们研究了13例骨髓增殖性疾病患者、18例不同类型贫血患者以及20名正常对照者。参考值定义为正常对照者平均值的95%概率限。在MDS患者中，52/62例（84%）类Pelger样细胞数量增加，40/62例（65%）有异常颗粒评分，而只有14/62例（23%）无颗粒中性粒细胞百分比增加。MDS患者的平均颗粒评分（±标准差）为（225.0±57.4），显著低于骨髓增殖性疾病患者（282.7±9.0）、贫血患者（288.8±8.0）和正常对照者（281.7±12.9）（p<0.001）。与骨髓增殖性疾病患者（1.1%±1.0）、贫血患者（3.1%±2.0）和正常对照者（1.9%±1.5）相比，MDS患者中类Pelger样中性粒细胞明显更常见（p<0.001）。个体患者中颗粒减少程度与类Pelger样细胞百分比之间无显著相关性。在MDS较不成熟的类型中，颗粒减少往往更明显，而类Pelger样细胞在不同亚组中同样常见。当将这两个参数结合起来时，92%的MDS病例可识别外周血发育异常。结果表明，对外周血多形核细胞中颗粒减少和核异常进行定量评估是MDS简单而有价值的诊断工具。
