福州大学内科学课件-第6章白血病.pptVIP

* xie Yi,Hua Shan Hospital * MICM TYPING DIAGNOSIS MICM Morphology Immunology Cytogenetics Molecular morphology lymphoblast myeloblast monoblast plasma 少，透明 中，Auer‘s 多，泡沫样 chromatin 粗粒 细砂 细 chromosome 短粗 细长 粗 Accompany 破碎C, 幼淋 粒系 幼单, 成熟单 POX － ＋/＋＋粗粒 －/＋细粒 NSE － －/+,NaF不抑制 ＋,NaF抑制 PAS 粗粒－结块 弥漫一片红 钟表面样 IMMUNO-PHENOTYPING　　　　　　　　 mab M1 M2 M3 M4 M5 M6 M7 CD13 + + + + + - - CD33 + + + + + - - CD14 - ± - + + - - CD41 - - - - - - + Ret - - - - - + - Lectoferrin - + - + - - - CD19 CD7 HLA-DR CD2 MPO T - + - + - B + - + - - 　　　　Chromosome translocation M1 +8,-5,-7 inv(3) M2 t(8;21) t(6;9) M3 t(15;17) M4 inv(16) M5 t(4;11), t(8;16) M6 M7 ALL t(9;22) (B) t(8;14) * xie Yi,Hua Shan Hospital * Fusion gene molecular AML1/ETO PML/RAR? CBF?/MYH11 MLL abnormalites BCR/ABL * xie Yi,Hua Shan Hospital * MICM TYPING DIAGNOSIS We could use traditional typing diagnosis as what FAB asked. If the situation permit, we could use FCM, chromosome, PCR or FISH in a WHO typing diagnosis way. * xie Yi,Hua Shan Hospital * Differential Diagnosis Myelodysplastic syndrome (MDS) refractory anemia or pancytopenia, BM: dysplasia, blasts30% Leukemoid reaction mature leukocytes proliferative would play a main role, NAP↑, if progenitor increase, only shortly on time CML: mature progenitors ↑ E↑、B↑， NAP=0, ph(＋)，bcr-abl(+) Stomatitis，Infectious mononucleosis，ITP, AA，agranulocytopenia There is no blasts in bone marrow principle: early，combine，full，interval，by stages why early ? The over hyperplasia infiltration could bring the difficulty on therapy Tumor lysis Leukemia cell enter into the area protected