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目的分析血液病患者发生自发性出血事件时的血小板特征。方法收集南京市4所医院出现自发性出血症状的6种血液病患者322例的资料,包括再生障碍性贫血(AA,41例)、原发免疫性血小板减少症(ITP,102例)、急性髓细胞白血病(AML,90例)及其中的急性早幼粒细胞白血病(APL,43例)、骨髓增生异常综合征(MDS,24例)、急性淋巴细胞白血病(ALL,22例)。分析发生出血事件时的血小板计数、血小板平均体积与血小板分布宽度。结果发生自发性出血事件时,AML组(APL除外)、ALL组和APL组的血小板计数分别为(16.09±10.92)×10~9/L、(22.59±17.66)×10~9/L和(24.16±16.29)×10~9/L,均高于AA组的(7.42±4.68)×10~9/L和ITP组的(8.06±6.77)×10~9/L(P<0.01)。ALL组和APL组出血时的血小板计数高于MDS组的(12.25±9.52)×10~9/L(P<0.01)。六组患者发生自发性出血事件时的血小板平均体积和分布宽度无明显差异(P>0.05)。结论 ALL与APL患者易出血,不能耐受较低的血小板计数。
Objective To analyze the platelet characteristics of spontaneous bleeding in patients with blood diseases. Methods The data of 322 patients with 6 hematologic diseases with spontaneous bleeding in 4 hospitals in Nanjing were collected, including aplastic anemia (AA, 41 cases), primary immune thrombocytopenia (ITP, 102 cases), acute Myeloid leukemia (AML, 90 cases) and acute promyelocytic leukemia (APL, 43 cases), myelodysplastic syndrome (MDS, 24 cases) and acute lymphoblastic leukemia (ALL, 22 cases). Platelet count, mean platelet volume, and platelet distribution width at bleeding events were analyzed. Results When spontaneous bleeding occurred, the platelet counts of AML group (except APL group), ALL group and APL group were (16.09 ± 10.92) × 10 ~ 9 / L, (22.59 ± 17.66) × 10 ~ 9 / L and 24.16 ± 16.29 × 10 ~ 9 / L, which were higher than those in AA group (7.42 ± 4.68) × 10 ~ 9 / L and ITP group (8.06 ± 6.77 × 10 ~ 9 / L, P <0.01. Hemorrhagic platelet counts in ALL and APL groups were significantly higher than those in MDS group (12.25 ± 9.52) × 10 ~ 9 / L (P <0.01). There was no significant difference in mean platelet volume and distribution width between spontaneous bleeding events in six groups (P> 0.05). Conclusion Patients with ALL and APL are prone to hemorrhage and can not tolerate lower platelet counts.