chapterιhematologicdisease-資料下載頁
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【正文】 eet ? difficulty walking ? nausea ? decreased appetite ? weight loss Symptoms ? irritability ? lack of energy or tiring easily (fatigue) ? diarrhea ? smooth and tender tongue ? increased heart rate (tachycardia) Symptoms 實驗室檢查 ? 一、血象 大細胞正色素或高色素型 MCV100μm3 MCH32pg。 ? 外周血以橢圓形大紅細胞居多，其染色較深。 ? 重癥 :多染性和嗜堿性點彩紅細胞。偶見卡波環(huán)及豪 周小體、巨大紅細胞或巨幼細胞。 ? 網(wǎng)織紅細胞計數(shù)不增高或輕度增高（ 3%）。 ? 白細胞 ↓ 粒細胞 :胞體增大，分葉過多，可至 5葉以上。個別患者外周血中可出現(xiàn)少數(shù)巨桿狀核細胞或巨晚幼粒細胞。 ? 血小板通常減少，可見體積如紅細胞大小的巨型血小板。 實驗室檢查 ? 二、 骨髓象 增生活躍 ? 紅系 ↑↑ :巨幼紅細胞增生為主，巨幼紅細 胞體積大，核染色質(zhì)疏松分散，核發(fā)育落后于細胞漿?？梢姾?周小體。 ? 粒系 :巨型桿狀核細胞，巨晚幼粒細胞及巨中幼粒細胞，分葉核粒細胞可見分葉過多。 ? 巨核細胞常 ↓ 亦可 → 或稍 ↑ ，可出現(xiàn)巨型巨核細胞和分葉過多之巨核細胞。 實驗室檢查 ? 三、生化檢查 ? 1．血清葉酸 正常人 ≥7ng/ml，葉酸缺乏時3ng/ml。 ? 2．紅細胞葉酸 正常人 165600ng/ml紅細胞，葉酸缺乏時 150ng/ml紅細胞。 ? 3．脫氧尿嘧啶核苷抑制試驗 葉酸或維生素 B12缺乏時不能抑制，加葉酸或維生素 B12可分別糾正其抑制率。 ? 4．血清維生素 B12正常人 15300pg/ml， B12缺乏時 90pg/ml，惡性貧血 40pg/ml。 ? 5．血清抗內(nèi)因子抗體：惡性貧血患者約 70%為陽性。 診斷 ?細胞形態(tài)學(xué)特點 、 ?臨床表現(xiàn) ?血清維生素 B12及葉酸水平測定。 ?診斷成立后必須進一步明確是葉酸缺乏還是維生素 B12缺乏所致。 Diagnose ? Megaloblastic (pernicious) anemia is usually discovered during a medical examination through a routine blood test. In addition to a plete medical history and physical examination, diagnostic procedures for megaloblastic (pernicious) anemia may include additional blood tests and other evaluation procedures, including the Schilling test. Diagnose ? The Schilling test is performed to detect vitamin B12 absorption. In the Schilling test, vitamin B12 levels are measured in the urine after the ingestion of radioactive vitamin B12. With normal absorption, the ileum (portion of the small intestine) absorbs more vitamin B12 than the body needs and excretes the excess into the urine. With impaired absorption, however, little or no vitamin B12 is excreted into the urine. 治療 ?病因治療 找出原發(fā)病因進行基礎(chǔ)疾病的治療 治療 ? 補充葉酸或維生素 B12 ? 1． 葉酸 適用葉酸缺乏者，口服 5 mg，每日三次，貧血糾正后，一般不需維持治療。胃腸道吸收不良者，可用四氫葉酸肌注 510 mg，每日 1次。 ? 2． 維生素 B12 適用于維生素 B12缺乏者。由于維生素 B12缺乏的原因大多與吸收不良有關(guān)，故給藥的方式應(yīng)該是肌肉注射。50100181。ｇ，每日或隔日肌注 1次，總量 mg，貧血糾正后改為 100181。ｇ，每月 1次。 Treatment ? Specific treatment for megaloblastic (pernicious) anemia will be determined by your physician based on: ? your age, overall health, and medical history extent of the disease your tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference Treatment may include vitamin B12 injections. Foods that are rich in folic acid include the following: ? orange juice ? oranges ? romaine lettuce ? spinach ? liver ? rice ? barley ? sprouts ? wheat germ ? soy beans Foods that are rich in folic acid include the following: ? green, leafy vegetables ? beans ? peanuts ? broccoli ? asparagus ? peas ? lentils ? wheat germ ? chick peas (garbanzo beans) Foods that are rich in folic acid and vitamin B12 include the following: ? eggs ? meat ? poultry ? milk ? shellfish ? fortified cereals Thank You
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