血常规的儿科临床实践教学中的解读(原创).ppt
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1、血常规在儿科临床实践教学中的解读,2023/12/27,儿科学教研室.临床实践教学,2,CBCBlood Routine,Red Blood CellRBCHemoglubinHbRed blood cell indices:MCV,MCH,MCHCHematocritHCT ReticulocyteRetWhite Blood CellWBC,leukocyteWhite blood cell types WBC differentialNeutrophils,Lymphocytes,Monocytes,Eosinophils,and BasophilsPlatelet(thrombocyt
2、e)PLT,BPCMean platelet volume MPV,2023/12/27,儿科学教研室.临床实践教学,3,Why It Is Done,Find the cause of symptoms such as fatigue,weakness,fever,bruising,or weight loss.Check for anemia.See how much blood has been lost if there is bleeding.Diagnosepolycythemia or Check for an infection.Diagnose diseases of the
3、 blood,such as leukemia.Check how the body is dealing with some types of drug orradiation treatment.Check how abnormal bleeding is affecting the blood cells and counts.Screen for high and low values before a surgery.See if there are too many or too few of certain types of cells.This may help find ot
4、her conditions,such as too many eosinophils may mean anallergyorasthmais present.,2023/12/27,儿科学教研室.临床实践教学,4,RBC&Hb,正常值随着年龄的变化而变化。,2023/12/27,4,2023/12/27,儿科学教研室.临床实践教学,5,RBC&Hb,正常值随着年龄的变化而变化。,2023/12/27,2023/12/27,儿科学教研室.临床实践教学,6,RBC&Hb,2023/12/27,6,2023/12/27,儿科学教研室.临床实践教学,7,2023/12/27,7,生后红细胞计数变化
5、,2023/12/27,儿科学教研室.临床实践教学,8,2023/12/27,8,生后Hb的变化 The change of the level of postnatal hemoglobin,回目录2,2023/12/27,儿科学教研室.临床实践教学,9,红细胞增多症,红细胞数目、血红蛋白、红细胞压积和血液总容量显著地超过正常水平。新生儿期RBC7.0109/L,Hb220g/L。儿童时期RBC5.0109/L,Hb180g/L(16g/dl),红细胞压积大于55%和每公斤体重红细胞容量绝对值超过35ml,排除因急性脱水或烧伤等所致的血液浓缩而发生的相对性红细胞增多,即可诊断。原发性的即真性
6、红细胞增多症继发性的主要是由组织缺氧所引起的。,2023/12/27,9,2023/12/27,儿科学教研室.临床实践教学,10,2023/12/27,10,最低标准 Hb minimum standard in normal children,*-WHO标准(1972)#-联合国儿童基金会标准(1986)*-国内标准(1989)(海拔每1000米,相应诊断标准中Hb4%),2023/12/27,儿科学教研室.临床实践教学,11,2023/12/27,11,RBC&Hb,生理性贫血 Physiologic anemia:Physiologic hemolysis Increased blood
7、 volumeTemporary hypofunction of myeloid hematopoiesis,使RBC生成不足,约23月时:RBC降至3.01012/L Hb降到100g/L左右,最低90g/L,生后Hb变化,2023/12/27,儿科学教研室.临床实践教学,12,2023/12/27,12,Graduation of anemia in children,2023/12/27,儿科学教研室.临床实践教学,13,2023/12/27,13,形态分类 Classification of morphology,贫血类型 MCV(fl)MCH(pg)MVHC(%)正常值 8094 2
8、832 3238正细胞性 8094 2832 3238大细胞性 94 32 3238 单纯小细胞性 80 28 3238 小细胞低色素性 80 28 32,2023/12/27,儿科学教研室.临床实践教学,14,2023/12/27,14,形态学与病因学的关系(Relation between morphology and etiology),RBC形态 病因 正细胞性 急性失血,溶血,再障,脾亢,肿瘤,急性感染大细胞性 DNA合成障碍:Vit.B12、叶酸缺乏,幼年性 恶性贫血,药物性贫血,红白血病 单纯小细胞性 缺铁早期,慢性感染,慢性疾病小细胞低色素性 Hb合成障碍:缺铁性贫血,地中海贫
9、血,铁 粒幼性贫血.,慢性失血,铅中毒,2023/12/27,儿科学教研室.临床实践教学,15,网织红细胞的意义,网织红细胞增多:表示骨髓红细胞生成旺盛,常见于溶血性贫血,特别是急性溶血(高达0.60.8)。急性失血后510天网织红细胞达高峰,2周后恢复正常。网织红细胞减少:提示骨髓增生功能低下。见于再生障碍性贫血,溶血性贫血再生危象、药物性骨髓抑制时,典型再生障碍性贫血,网织红细胞计数常低于0.005.网织红细胞绝对值低于15109/L为再生障碍性贫血的诊断标准之一。,2023/12/27,15,2023/12/27,儿科学教研室.临床实践教学,16,2023/12/27,16,Disast
10、er of Leukecytes,Neoplastic Disorders of Leukocytes MDS;Myelodysplastic syndrome Non-Neoplastic Disorders of Leukocytes,2023/12/27,儿科学教研室.临床实践教学,17,2023/12/27,17,不同年龄的白细胞水平变化,Cord blood:1520109/L612h:2128109/L1w:12109/L1y:10109/L1y:412109/L,Leucocyte,2023/12/27,儿科学教研室.临床实践教学,18,White blood cell type
11、s(WBC differential)in Adult,2023/12/27,儿科学教研室.临床实践教学,19,2023/12/27,19,2023/12/27,儿科学教研室.临床实践教学,20,2023/12/27,20,Neoplastic Disorders of Leukocytes,Leukemia(acute,chronic)Lymphocytic Leukemia(ALL,CLL)Non-Lymphocytic Leukemia(myelogenous leukemia)(AML,CML)LymphomaHodgkins lymphomaNon Hodgkin lymphoma
12、Histiocytosis(malignant,Langerhans cell)OthersMultiple myelomaNeuroblastoma etc.,2023/12/27,儿科学教研室.临床实践教学,21,2023/12/27,21,Myelodysplastic syndrome,Refractory anemia(RA):Refractory neutropenia,Refractory anemia with ringed sideroblasts(RARS):Refractory cytopenia with multilineage dysplasiaRefractory
13、 anemia with excess blasts(RAEB):Refractory anemia with excess blasts I and II.RAEB was divided into*RAEB-I(5-9%blasts)and RAEB-II(10-19%)blasts,which has a poorer prognosis than RAEB-I.Refractory anemia with excess blasts in transformation(RAEB-T):characterized by 21-30%myeloblasts in the marrow Ch
14、ronic myelomonocytic leukemia(put in a new category of myelodysplastic-myeloproliferative overlap syndromes.),2023/12/27,儿科学教研室.临床实践教学,22,2023/12/27,22,Non-Neoplastic Disorders of Leukocytes,Qualitative DisordersFunctional defectQuantitative DisordersLeukocytosis:Neutrophilia,Lymphocytosis,Monocytos
15、is,Eosinophilia,BasophiliaLeukopenia:Granulocytopenia(Agranulocytosis),Lymphocytopenia,2023/12/27,儿科学教研室.临床实践教学,23,2023/12/27,23,Defects of Neutrophil Function,Chronic granulomatous disease(慢性肉芽肿性疾病)X-linked or autosomal recessiveInability to generate H2O2Recurrent infections by catalase-positive or
16、ganisms(Staphylococcus,Serratia,Salmonella)Myeloperoxidase deficiency(髓过氧物酶缺乏)Autosomal recessiveRecurrent candidal infections,2023/12/27,儿科学教研室.临床实践教学,24,2023/12/27,24,Defects of Neutrophil Function,Chediak-Higashi Syndrome(谢迪亚克东综合征,即白细胞异常色素减退综合征)Autosomal recessiveFused lysosomes giant granules in
17、 leukocytesNeutropenia,impaired chemotaxis and bactericidal activityBacterial and fungal infections,defective platelet aggregation(prolonged bleeding time),oculocutaneous albinismAccelerated phase(lymphoproliferative disorder),2023/12/27,儿科学教研室.临床实践教学,25,2023/12/27,Blood diseases in childhood,25,Che
18、diak-Higashi syndrome giant granules in leukocytes,2023/12/27,儿科学教研室.临床实践教学,26,2023/12/27,26,Leukocytosis,Leukocytosis is a white blood cell count(the leukocyte count)above the normal range in the blood.,2023/12/27,儿科学教研室.临床实践教学,27,2023/12/27,27,Vary with age,Cord blood:930109/L612h:2128109/L2w:5211
19、09/L6m6y:615109/L6y:4.513.5109/L,Leucocyte,2023/12/27,儿科学教研室.临床实践教学,28,2023/12/27,28,Blood Cell Indices During Gestation and at Birth,2023/12/27,儿科学教研室.临床实践教学,29,2023/12/27,29,Leukemoid reaction,类白血病反应(leukemoid reaction)是指患者在某些情况下出现外周血白细胞显著增高(50109/L)和(或)存在有异常未成熟白细胞,与某些白血病相类似,但随后病程或尸检证实没有白血病。类白血病反应
20、是正常骨髓对某些刺激信号作出的一种反应。,2023/12/27,儿科学教研室.临床实践教学,30,2023/12/27,30,类白血病反应的病因,1.感染是最常见的原因常见病原体有细菌、螺旋体、原虫、病毒等。分为以下几类:(1)粒细胞型类白血病反应:常见于肺炎、脑膜炎、白喉、结核病(主要为粟粒性结核、浸润性结核溶解播散期肺外结核)等重症传染病。(2)淋巴细胞型类白血病反应:常见于百日咳、水痘、传染性单核细胞增多症、传染性淋巴细胞增多症、结核病等。(3)单核细胞型类白血病反应:常见于结核病、巨细胞病毒感染、亚急性细菌性心内膜炎等。(4)嗜酸性粒细胞型类白血病反应:常见于寄生虫感染,如血吸虫病、丝
21、虫病、疟疾、棘球蚴病(包虫病)等。,2023/12/27,儿科学教研室.临床实践教学,31,2023/12/27,31,类白血病反应的病因,2.恶性肿瘤多见于晚期患者肺和胃肠道恶性肿瘤,尤其是转移到肝骨髓后易发生类白血病反应。多发性骨髓瘤、霍奇金病、黑色素瘤骨肉瘤、乳腺癌、绒毛膜上皮癌肿瘤引起的类白血病反应多属粒细胞型亦有类似红白血病,淋巴细胞型较少见并常伴有贫血和血小板减少。,2023/12/27,儿科学教研室.临床实践教学,32,2023/12/27,32,类白血病反应的病因,3.中毒(1)化学因素:如汞、有机磷、苯、亚硝酸盐等中毒。(2)药物性:如砷剂、解热镇痛药、磺胺药、肾上腺素糖皮质
22、激素、锂盐等。还有报道:用大剂量阿糖胞苷治疗急性白血病缓解期引起的类白血病反应,易误诊为“复发”。(3)其他:一氧化碳中毒四氯乙烷中毒、尿毒症、酮症酸中毒、食物中毒等。,2023/12/27,儿科学教研室.临床实践教学,33,2023/12/27,33,类白血病反应的病因,4.急性失血与溶血任何原因引起的大出血、急性血管内溶血。5.急性组织损伤常见于外伤性组织创伤(如颅脑外伤、挤压综合征)、大面积烧伤、电休克等。6.其他疾病变态反应性疾病(如剥脱性皮炎过敏性肺炎)高热中暑电离辐射性疾病脾切除术后,2023/12/27,儿科学教研室.临床实践教学,34,2023/12/27,34,类白血病反应的
23、诊断,1.有明确的病因,如感染中毒、恶性肿瘤等;2.原发病治愈或好转后,类白血病反应可迅速消失;3.血红蛋白、血小板计数大致正常。4.骨髓检查:反应性增生,2023/12/27,儿科学教研室.临床实践教学,35,2023/12/27,35,Neutrophilia,Neutrophil leukocytosis,Neutrophilic granulocytosis年龄大于1个月的儿童和各年龄组成人外周血中性杆状核和分叶核粒细胞计数大于7.5109/L小于1个月的婴儿大于26109/L中性粒细胞比值明显高于同年龄儿童,2023/12/27,儿科学教研室.临床实践教学,36,2023/12/27
24、,36,Neutrophilia,原因:Infections:bacteria,some virusNeoplasms:Hemorrhage,hemolysisHereditaryImmunological inflammation rheumatoid arthritis,vasculitisDrugs glucocorticoids,colony stimulating factors,lithiumMetabolic acidosis,uremia,goutTissue necrosis infarction,burns,trauma,cold,hot,sport,anoxia,emot
25、ional,2023/12/27,儿科学教研室.临床实践教学,37,2023/12/27,37,中性粒细胞型类白血病反应,白细胞计数50109/L,或外周血白细胞计数50109/L,但出现原粒、幼粒细胞成熟中性粒细胞胞质中常出现中毒性颗粒和空泡碱性磷酸酶积分明显增高骨髓象除了有粒细胞增生和左移现象外,没有白血病细胞的形态异常,2023/12/27,儿科学教研室.临床实践教学,38,2023/12/27,38,Lymphocytosis,Absolute lymphocytosis:the absolute lymphocyte countAdult:4109/LOlder children 7
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