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急性早幼粒细胞白血病快速实验室诊断的重要性。

The Importance of Rapid Laboratory Diagnosis of Acute Promyelocytic Leukemia.

出版信息

Clin Lab. 2024 Jun 1;70(6). doi: 10.7754/Clin.Lab.2024.240116.

Abstract

BACKGROUND

Acute promyelocytic leukemia (APL) is a specific type of acute myeloid leukemia [1,2], the onset of the disease is insidious and the disease progresses rapidly, and failure to detect it in time or missing the best time to seek medical treatment is likely to cause secondary cerebral hemorrhage and lead to early death (ED: deaths occur in the first 30 days post diagnosis) [3-5].

METHODS

A patient with APL was rapidly identified by peripheral blood image, fibrinogen (FIB), and D-dimer within 24 hours. Finally, APL was confirmed by bone marrow cell morphology, molecular biology, and cytogenetics.

RESULTS

The presence of faggot cells with Auer rods in the peripheral blood image and the coagulation function changes abnormally at the same time. Once the above abnormal results are found, APL should be highly suspected and timely reported to the clinic for corresponding treatment.

CONCLUSIONS

APL is a critical disease, the time limit for definitive diagnosis should be calculated in hours rather than days. Peripheral blood smear microscopic examination can effectively screen out rare promyelocytes and combine with abnormal FIB and D-dimer results that are highly suspicious of APL. These methods have important clinical significance in the initial screening, early diagnosis, and reduction of early mortality due to APL.

摘要

背景

急性早幼粒细胞白血病(APL)是一种特定类型的急性髓系白血病[1,2],疾病发病隐匿且进展迅速,如果不能及时发现或错失最佳就医时机,可能会导致继发性脑出血,进而导致早期死亡(ED:在诊断后 30 天内死亡)[3-5]。

方法

通过外周血图像、纤维蛋白原(FIB)和 D-二聚体在 24 小时内快速识别 APL 患者。最终通过骨髓细胞形态学、分子生物学和细胞遗传学确认 APL。

结果

外周血图像中出现带 Auer 棒的成束细胞,同时凝血功能异常。一旦发现上述异常结果,应高度怀疑 APL,并及时向临床报告,以便进行相应治疗。

结论

APL 是一种危急重症,确诊时限应以小时计算,而非天数。外周血涂片显微镜检查可以有效筛出罕见早幼粒细胞,并结合异常 FIB 和 D-二聚体结果,高度怀疑 APL。这些方法在外周血异常的初始筛查、早期诊断和降低 APL 早期死亡率方面具有重要的临床意义。

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