Steiger R, Feige K
Klinik für Wiederkäuer- und Pferdemedizin der Universität Zürich.
Schweiz Arch Tierheilkd. 1995;137(7):306-11.
A 13 year old Thoroughbred gelding was presented with a history of a single episode of collapse during mild exercise. Clinical examination revealed a high packed cell volume (PCV) of 72%, a haemoglobin concentration of 24.9 g/l and 15.2 millions erythrocytes/microliters. Despite continuous intravenous infusion therapy with large volumes, the PCV never decreased to a physiological level. The animal showed a normal appetite and no signs of discomfort or syncope. Arterial blood gas values were in the normal range as well as the concentration of erythropoietin (measured by radioimmunoassay, RIA). A test for neoplasms (carcino-embryonic antigen, CEA) was negative. The liver enzymes of the animal were extremely elevated and a liver biopsy showed a severe fibrosis. Examination of sternal bone marrow aspirate revealed no abnormalities. Based on these findings, the presumptive diagnosis was "absolute polycythaemia". The animal was treated for 7 days with repeated phlebotomy. During this time, the PCV never decreased below 50%, despite no obvious signs of discomfort from the animal. Because of the poor prognosis based on the liver biopsy result, the animal was euthanized 11 days after hospitalization. Post mortem findings were: a granular cell myoblastoma with a diameter of approximately 5 cm in the lungs, severe fibrosis of the liver, mild acute tubular nephrosis in the kidneys, activation of the erythropoietic cells in the bone marrow and thrombosis of the abdominal aorta. The possibility of secondary polycythaemia due to the lung neoplasia was not entirely excluded, but considered to be unlikely. Therefore, the definite diagnosis was polycythemia vera.(ABSTRACT TRUNCATED AT 250 WORDS)
一匹13岁的纯种马 gelding 因在轻度运动时出现单次虚脱病史前来就诊。临床检查发现红细胞压积(PCV)高达72%,血红蛋白浓度为24.9 g/l,红细胞计数为1520万/微升。尽管持续进行大量静脉输液治疗,但PCV从未降至生理水平。该动物食欲正常,无不适或晕厥迹象。动脉血气值以及促红细胞生成素浓度(通过放射免疫测定法,RIA测量)均在正常范围内。肿瘤标志物检测(癌胚抗原,CEA)为阴性。该动物的肝脏酶极度升高,肝脏活检显示严重纤维化。胸骨骨髓穿刺检查未发现异常。基于这些发现,初步诊断为“绝对性红细胞增多症”。该动物接受了7天的反复放血治疗。在此期间,尽管动物没有明显不适迹象,但PCV从未降至50%以下。由于肝脏活检结果显示预后不佳,该动物在住院11天后实施安乐死。尸检结果如下:肺部有一个直径约5厘米的颗粒细胞瘤,肝脏严重纤维化,肾脏轻度急性肾小管坏死,骨髓中促红细胞生成细胞活化,腹主动脉血栓形成。虽未完全排除因肺部肿瘤导致继发性红细胞增多症的可能性,但认为可能性不大。因此,明确诊断为真性红细胞增多症。(摘要截取自250字)