acute agranulocytosis
Introduction
Introduction to acute neutropenia Acute agranulocytosis (acuteagranulocytosis) is a more severe manifestation of neutropenia. It refers to a sudden onset of granulocytes, with an absolute value of <0.5×109/L, a syndrome characterized by febrile infection. basic knowledge The proportion of illness: 0.052% Susceptible people: no special people Mode of infection: non-infectious Complications: sepsis
Cause
Acute granulocytosis
(1) Causes of the disease
It is related to exposure to drugs, especially aminopyrine. It has been found that in addition to aminopyrine, phenylbutazone, sulfonamides, thiouracils, etc. can occasionally be caused.
(two) pathogenesis
Its pathogenesis is currently thought to be an immune-mediated drug response: anti-neutrophil antibodies produced by drug-sensitized patients not only cause rapid destruction of granulocytes, but also directly damage various stages of granulocyte in the bone marrow. The formation of obstacles, abnormal distribution, and finally lead to a serious lack of granulocytes.
Prevention
Acute neutropenia prevention
Avoid or reduce the use of aminopyrine and sulfonamides.
Complication
Acute neutropenia Complications sepsis
The main complication is infection, and severe cases can be complicated by sepsis.
Symptom
Acute agranulocytosis symptoms common symptoms high fever chills
Rapid onset, chills or chills, high fever, headache, weakness, often accompanied by oral mucosa, gums, tongue, soft palate, and necrotizing necrotic ulcers, covered with gray or green-black pseudomembrane, rectum, anus, vagina, uterus The same mucosa also occurs in the same ulcer, submandibular, cervical lymph nodes are often swollen, a few cases have jaundice and liver, splenomegaly, disease progression can cause infection in the lungs or other parts, until sepsis, like other granulocyte deficiency, infection lesions The inflammatory infiltration is not obvious, the pus is rarely formed, and about 10% of patients have a rash.
Examine
Acute neutropenia check
Peripheral blood
The total number of white blood cells is below 2.0×109/L, and the absolute value of granulocytes is less than 0.5×109/L. The granulocytes in the classification only account for 1% to 2%, or even less, and the granulocyte nucleus is pyknotic, in the cytoplasm. Cavitation and coarse particles appear, lymphocytes and monocytes are relatively increased, red blood cells and platelets are generally normal. When the recovery period, the number of white blood cells in the peripheral blood increases, sometimes several times higher than the normal value, and early progranules, mesozoic and Late myelocytes exhibit a leukemia-like response.
2. Bone marrow examination
The hyperplasia is moderately low or active, the erythroid and megakaryocyte lines are normal, and the granulocyte cell line is significantly reduced below the neutrophil stage. It is easy to be mistaken for maturity stagnation, sometimes the granulocyte cell proliferation is extremely low, only a few granules and early granules are seen. Cells, plasma cells, lymphocytes and reticulocytes can be increased.
Diagnosis
Diagnosis and differentiation of acute granulocyte deficiency
diagnosis
According to sudden onset, neutropenia, a history of drug exposure, and bone marrow characteristics, it is generally not difficult to diagnose.
Differential diagnosis
When the promyelocytes in the bone marrow are relatively increased, they must be differentiated from acute leukemia. In addition, some drugs cause acute aplastic anemia, often preceded by neutropenia, followed by a decrease in whole blood cells.
