资源描述：
《邹善华－再生障碍性贫血.ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、AplasticAnemia(AA)ZhongshanHospital,FudanUniversityZouShanhua。OutlineBonemarrowhematopoiesisfailureledbychemicals,radiation,biologicalfactorsandunknownetiology.Thecommonclinicalpresentationismildtoseverepancytopenia.EpidemiologyTheincidencerateofAA:0.74per100,000，AAA:0.14per100,0
2、00,CAA:0.60per100,000.Distribution：mostAApatientsareyoungandmiddle-agedpeople,malemorethanfemaleEtiologyPrimaryAA：unknowncauses，about60~70%SecondaryAAEtiologyofSecondaryAAChemicalsDrug:antibiotics,antineoplasticagent,NSAIDsOtherchemicals:benzeneandbenzenederivatives,arsenic,heavy
3、metals,insecticidesEtiologyofSecondaryAARadiationViralinfection：Hepatitisvirus,EBVMechanismHematopoieticstemcelldefectStemcellscountdecreaseStemcellsproliferationcapacitydecreaseMechanismHematopoieticmicroenviromentdefectstromalcellshematopoieticgrowthfactormicrocirculationMechan
4、ismImmunologicderangementCD4/CD8（↓,inversion)γ-IFN,TNFα,IL-2↑immunosuppressivetherapyClinicalFeaturesClinicalfeatures:anemia,infection,hemorrhageDifferences:AAA(SAA-Ⅰ),CAA,SAA-ⅡLaboratorystudy—completebloodcountCommonfeature：anemia,reticulocytecount↓granulocytopeniathrombocytopen
5、iapercentoflymphocyteincreaserelativelyLaboratorystudy—completebloodcountSAA:Ret<1%Granulocytecount<0.5×109/LBPC<20×109/LCAA:Ret>1%Granulocytecount>0.5×109/LBPC>20×109/LLaboratorystudy－bonemarrowCommonfeature：Nakedeye：bonemarrowisplentyofoildropsMicroscope：hypoplasiaorpolarhypopl
6、asia;hematopoieticcellsdecrease，nonhematopoieticcellsincreaseLaboratorystudy－bonemarrowSAA:polarhypoplasia,progenitorcellcanhardlybeseen,nomegakaryocyteCAA:hypoplasia,megakaryocytesdecreaseordisappearLaboratorystudy－bonemarrowbiopsyMorevaluablethanmarrowaspirationRatioofhematopoi
7、etictissue/fattytissueMegakaryocyteproliferationcanbeevaluatedaccurately;LaboratorystudyCFU-GM↓NAP↑EPO↑CriteriaofdiagnosisPancytopenia,reticulocyteabsolutecount↓WithoutsplenomegalyHypoplasiaorpolarhypoplasiaofbonemarrow;ifnot,megakaryocyteshoulddisappear;Biopsy:hematopoietictissu
8、e↓fattytissue↑Excludingotherdiseaseswith
