reactive plasmacytosis
Introduction
Introduction to reactive plasmacytosis Reactive plasmacytosis (RP) refers to a group of clinical syndromes characterized by multiple bone marrow mature plasma cells caused by multiple causes or primary diseases. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: disseminated intravascular coagulation
Cause
Causes of reactive plasmacytosis
Virus infection (35%):
Common causes of the disease include viral infections, allergic diseases, connective tissue diseases, tuberculosis and other chronic infectious diseases, chronic liver diseases, malignant tumors and aplastic anemia, agranulocytosis, myelodysplastic syndrome and other hematopoietic systems. disease.
Aplastic anemia (25%):
Aplastic anemia (AA, referred to as aplastic anemia) is a group of syndromes with bone marrow dysfunction caused by multiple causes, with total cytopenia as the main manifestation. The annual incidence rate in China is about 0.74/100,000. The exact cause is not known, and the incidence of aplastic anemia is known to be related to chemical drugs, radiation, viral infections, and genetic factors.
Pathology (35%):
Increased reactive plasma cells (RPC) may be associated with increased concentrations of IL-2, IL-10, and IL-6 in the bone marrow hematopoietic microenvironment.
Prevention
Reactive plasmacytosis prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Reactive cytoplasmic complications Complications, disseminated intravascular coagulation
The main complications are severe liver and kidney damage and disseminated intravascular coagulation, and central nervous system damage, which aggravates the condition and is life-threatening.
Symptom
Symptoms of reactive plasmacytosis Common symptoms Amyloidosis dizziness
There are various clinical manifestations, which vary with the primary disease and are not related to the increase of plasma cells. Therefore, it is one of the main clues for the diagnosis of primary diseases.
The diagnosis of this disease is mainly determined by the quality and quantity of plasma cells in the bone marrow.
Examine
Examination of reactive plasmacytosis
1. Peripheral blood: Plasma cells are occasionally found in blood smears.
2. Bone marrow: The proportion of bone marrow plasma cells is 3%, generally less than 10%, but a few patients can be greater than 10% or even as high as 50%. Such cells are generally more mature plasma cells with lower acid phosphatase scores.
3. Bone marrow biopsy: Pulp cells are rare or nodular, and plasma cells are more common around the blood vessels.
4. Immunohistochemical staining: Reactive plasma cells are often elevated in CD31 CD23-CD56-, Ber-H2/CD30, KP1/CD68, LCA/CD45, EMA and pancytokeratin/KL1, and the detection of these phenotypes helps In addition to the identification of neoplastic plasma cells, in addition, the ratiometric determination of kappa and lambda light chain plasma cells is also a method for clonal identification.
5. Serum protein electrophoresis: It can be seen that the immunoglobulin region is a polyclonal thickening band, and there is no single plant peak.
6. Flow cytometry detection: RPC precursor cells with phenotype CD19+CD28-CD138- in peripheral blood mononuclear cells can be detected, which can help identify with MM.
7. Cellular and molecular genetic analysis: The expression of anti-apoptotic factors BAX and BCL-2 in plasma cells is significantly higher in MM than in RP. In addition, plasma cell karyotype analysis, IgH gene rearrangement and other molecular biological examinations are necessary. Can be used for the identification of benign and malignant plasma cells.
Diagnosis
Diagnosis and identification of reactive plasmacytosis
Diagnostic criteria
1. Domestic diagnostic criteria
(1) There are causes or primary diseases that cause RP.
(2) Clinical manifestations are related to the primary disease.
(3) -globulin and/or immunoglobulin are normal or slightly elevated, and it is more common to increase polyclonal IgG.
(4) bone marrow plasma cells 3%, generally mature cells, which is the main basis for diagnosis.
(5) can exclude multiple myeloma, extramedullary plasma cell tumor, macroglobulinemia, heavy chain disease, primary amyloidosis.
2. The foreign diagnostic criteria are the same as the domestic diagnostic criteria except that the bone marrow plasma cells are required to be 4%.
Differential diagnosis
Reactive plasmacytosis mainly needs to be differentiated from clonal plasma cell disease, because the two have the common characteristics: the increase of bone marrow plasma cells, but in fact, the plasma cells of the two are different, and the plasma cells of RP are reactive. Polyclonal, while the latter is a malignant monoclonal plasma cell, so the most fundamental point to identify the two is plasma cell polyclonal, monoclonal or benign, malignant identification, it is worth noting that a small number of reactive pulp Patients with hyperplasia may develop elevated immunoglobulins. If the primary disease persists, some of the patients' polyclonal antibodies may evolve to the monoclonal over time, and secondary MGUS may be diagnosed in the presence of monoclonal. .
