Savage D G, Allen R H, Gangaidzo I T, Levy L M, Gwanzura C, Moyo A, Mudenge B, Kiire C, Mukiibi J, Stabler S P, Lindenbaum J
Department of Haematology, University of Zimbabwe School of Medicine, Harare.
Am J Med Sci. 1999 Jan;317(1):22-32. doi: 10.1097/00000441-199901000-00004.
There has been little systematic study of the clinical spectrum of pancytopenia, and the optimal diagnostic approach to pancytopenia remains undefined.
The authors studied 134 hospitalized pancytopenic patients in Zimbabwe in both consecutive and nonconsecutive fashion.
The most common cause of pancytopenia was megaloblastic anemia, followed by aplastic anemia, acute leukemia, acquired immunodeficiency syndrome (AIDS), and hypersplenism. Severe pancytopenia was usually due to aplastic anemia. Patients with aplastic anemia and acute leukemia were usually children, whereas those with megaloblastic anemia were adults. Moderate to severe anemia was noted throughout the series, but was most striking in patients with megaloblastic anemia, aplastic anemia, and acute leukemia. The mean corpuscular volume (MCV) was elevated in most patients with megaloblastic hematopoiesis, aplastic anemia, and acute nonlymphocytic leukemia. Normal or low MCV values were noted in almost one third of patients with megaloblastic anemia. Anisocytosis, poikilocytosis, macroovalocytosis, microcytosis, fragmentation, and teardrop erythrocytes were more prominent on the blood films of patients with megaloblastic anemia.
Megaloblastic anemia, aplastic anemia, and AIDS are the most common causes of pancytopenia in Zimbabwe. Aplasia is the most frequent cause of severe pancytopenia. The authors have formulated tentative guidelines for the evaluation of pancytopenic patients in this setting.
关于全血细胞减少的临床谱鲜有系统研究，且全血细胞减少的最佳诊断方法仍不明确。
作者以连续和非连续的方式研究了津巴布韦134例住院的全血细胞减少患者。
全血细胞减少最常见的原因是巨幼细胞贫血，其次是再生障碍性贫血、急性白血病、获得性免疫缺陷综合征（艾滋病）和脾功能亢进。严重全血细胞减少通常由再生障碍性贫血引起。再生障碍性贫血和急性白血病患者多为儿童，而巨幼细胞贫血患者多为成人。整个系列中均观察到中度至重度贫血，但在巨幼细胞贫血、再生障碍性贫血和急性白血病患者中最为明显。大多数巨幼细胞造血、再生障碍性贫血和急性非淋巴细胞白血病患者的平均红细胞体积（MCV）升高。几乎三分之一的巨幼细胞贫血患者MCV值正常或偏低。巨幼细胞贫血患者血涂片上异形红细胞、异形红细胞症、大卵圆形红细胞、小红细胞、破碎红细胞和泪滴状红细胞更为突出。
巨幼细胞贫血、再生障碍性贫血和艾滋病是津巴布韦全血细胞减少最常见的原因。再生障碍是严重全血细胞减少最常见的原因。作者制定了在此情况下评估全血细胞减少患者的初步指南。
