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近年在杭州市红十字会医院和浙医一院血液科骨髓室共发现3例口服乙双吗啉诱发急性非淋巴细胞性白血病(ANLL),报告如下,提请临床注意。 例1:男,57岁。因患银屑病2年来间断服用乙双吗啉。近1周来反复牙龈出血,自诉乏力,于1991年2月9日入院。体检:T38.2℃,P92次/分,R19次/分,BPl5/10kPa,神志清,全身散在性皮疹,浅表淋巴结未及,两肺呼吸音清晰,心尖区Ⅱ级收缩期杂音,肝脾肋下未及。血象:Hb92g/L,WBC1.8×10~9/L,血小板计数7×10~9/L。PT22秒(对照14秒),3P试验强阳性,纤维蛋白原32g/L。骨髓象:原粒细胞0.035,早幼粒细胞0.85,嗜酸性晚幼粒细胞0.01,中幼红细胞0.02,晚幼红细胞0.015,淋巴细胞0.06。诊断为ANLL—M_(3a),并发DIC。 例2:男,43岁。有银屑病史10余年,长期服乙双吗啉,近已停服40余天。1周前皮肤出现青紫块,口腔有血泡,伴发热2天。于1992年2月18日入院。体检:心肺听诊正常,浅表淋巴结未及,肝脾肋下未及。血象:
In recent years, 3 cases of oral B-morpholine-induced acute non-lymphocytic leukemia (ANLL) were found in Hangzhou Red Cross Hospital and Zhejiang Medical First Hospital Department of Hematology. The report is as follows, to draw clinical attention. Example 1: Male, 57 years old. 2 years because of psoriasis intermittent taking B double morpholine. Almost 1 week to repeated bleeding gums, private prosecution fatigue, admitted to hospital on February 9, 1991. Physical examination: T38.2 ℃, P92 beats / min, R19 beats / min, BPl5 / 10kPa, conscious mind, systemic rash, superficial lymph nodes, pulmonary breath sounds clear, apical systolic murmur, liver Spleen under the ribs. Blood: Hb92g / L, WBC1.8 × 10 ~ 9 / L, platelet count 7 × 10 ~ 9 / L. PT22 seconds (control 14 seconds), 3P test strongly positive, fibrinogen 32g / L. Bone marrow as follows: 0.035 neutrophils, 0.85 promyelocytic cells, 0.01 eosinophils, 0.02 neutrophils, 0.015 neutrophils, and 0.06 lymphocytes. Diagnosis of ANLL-M_ (3a), concurrent DIC. Example 2: Male, 43 years old. Psoriasis has a history of more than 10 years, long-term service B-morpholine, has almost stopped taking more than 40 days. 1 week ago the skin appears purple blocks, oral blood bubble, with fever for 2 days. Admitted to hospital on February 18, 1992. Physical examination: Cardiopulmonary auscultation normal, superficial lymph nodes and liver and spleen ribs. Blood: