Myelopathic anemia

Introduction to myelopathy anemia Myelopathic anemia (MA) or bone marrow infiltrating anemia is an anemia caused by destruction of the bone marrow by tumor cells or abnormal tissues, damage to the hematopoietic bone marrow microenvironment, and impaired hematopoietic function. It is characterized by bone pain, bone destruction, anemia with young red blood cells. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: anemia of chronic diseases

Cause of myelopathy anemia

Metastatic cancer (25%):

Thyroid cancer, stomach cancer, colorectal cancer, lung cancer, liver cancer, breast cancer, kidney cancer, prostate cancer, neuroblastoma, and almost all cancers can be transferred to the bone marrow.

Hematopoietic tumors (20%):

1 stem cell disease: acute myeloid leukemia, chronic myeloid leukemia, polycythemia vera, primary myelofibrosis;

2 non-stem cell diseases: acute lymphocytic leukemia, chronic lymphocytic leukemia, multiple myeloma, malignant histiocytosis, malignant lymphoma.

Infection, inflammation (15%):

Bacterial (tuberculosis, staphylococcus, typhoid, etc.), fungi (tissue cytoplasmic bacteria), etc.

Metabolic disease (15%):

Mononuclear phagocytic system accumulation disease (Gaucher disease), mononuclear phagocytic system hereditary defect disease (osteosclerosis).

Pathogenesis

The above causes cause various degrees of anemia through a combination of various factors.

1. Infiltration of bone marrow by tumor or abnormal tissue: The bone marrow microenvironment is destroyed, resulting in impaired normal hematopoietic function, anemia occurs, and the young bone red blood cell blood image appears due to the destruction of the bone marrow-blood barrier.

2. Extramedullary hematopoiesis: After the bone marrow is invaded, compensatory extramedullary hematopoiesis may occur in the body. Extracellular EPO may also be stimulated by increased EPO in cancer patients. The main sites are spleen, liver and lymph nodes, extramedullary hematopoiesis. Lack of barrier appears young particles, red blood cells, spleen enlargement and secondary spleen hyperfunction caused by complete blood cell reduction.

3. Metastatic cancer forms infiltrates or bone marrow necrosis in the bone marrow: the surrounding hematopoietic tissue may be poorly proliferated and may be replaced by fibrous tissue, which may be caused by the release of hematopoietic inhibitors and fibroblast growth factors by tumor cells.

4. Ineffective generation of red blood cells, complicated by microangiopathic hemolytic anemia, the production of autoimmune antibodies leads to shortened red blood cell life, increased damage, iron nucleated cell anemia due to poor iron utilization, but less common.

5. Blood loss: Gastrointestinal tumors, cervical cancer are easy to merge with hemorrhage, causing blood loss; tumor tissue release thromboplastin, thrombosis and DIC also cause bleeding.

6. Nutritional deficiency: Loss of appetite in patients with cancer, lack of acid acid, lack of folic acid, lack of protein, tumor and toxin inhibit hematopoiesis, interfere with the normal utilization of iron, protein, folic acid and vitamin B12.

7. Radiotherapy, chemotherapy, severe infection inhibits hematopoietic function.

Myeloid anemia prevention

Active treatment of the primary disease.

Bone marrow anemia complications Complications anemia of chronic diseases

Long-term chronic anemia can cause anemia in heart disease.

Symptoms of myelopathy anemia Common symptoms Thrombocytopenia bleeding tendency abdominal pain hepatosplenomegaly nausea medullary sponge kidney coma diarrhea polyuria neonatal anemia

1. Symptoms and signs of the primary disease: often due to the symptoms of the primary disease to cover up the performance of secondary anemia, may also be anemia and bone pain as the first symptom and lack the clinical manifestations of the primary disease.

2. Anemia is an important common symptom: different severity, progressive aggravation, anemia degree and tumor size range and bone marrow infiltration degree are not significantly related, with folic acid, iron, vitamin B12 and other treatments are invalid, combined infection can aggravate the degree of anemia.

3. Extramedullary hematopoietic manifestations of liver, spleen, and swollen lymph nodes.

4. Hemorrhagic tendency to thrombocytopenia, or with DIC, may have varying degrees of bleeding.

5. Bone pain: bone pain in one or more parts, such as low back pain, may be accompanied by local uplift, tenderness, and even pathological fractures. There may be severe pain in bone marrow necrosis, and may also be accompanied by arrhythmia, polyuria, and nausea. Vomiting, abdominal pain, diarrhea, and even coma.

Examination of myeloid anemia

1. Blood: Positive cells are pigmented anemia, combined with obvious hemorrhage or folic acid deficiency, can present small cell hypopigment or large cell anemia, red blood cell size is uneven, abnormal, multi-staining and basophilic red blood cells, combined with bone marrow There are teardrop-like red blood cells in the fibrosis, blood smears can see more nucleated red blood cells and immature granulocytes, and even the naked nucleus of megakaryocytes, reticulocytes are mostly normal, combined with hemolysis can increase, white blood cell count increases, can also be reduced or Normal, thrombocytopenia, normal or increased, common large deformed platelets.

2. Bone marrow: There is a phenomenon of "dry pumping" when bone marrow puncture, bone marrow hyperplasia is active, anemia of bone marrow is rapid, and anaemia-like anemia can occur. In the case of red blood cells, the possibility of tumor should be considered. The smear should be punctured at the tenderness of the epiphysis, or the metastatic tumor cells can be found by bone marrow biopsy.

3. Serum alkaline phosphatase, lactate dehydrogenase activity can be increased.

4. Mature neutrophil alkaline phosphatase activity increased.

5. Serum iron (SI) is reduced, total iron binding capacity (TIBC) is normal or slightly reduced, plasma iron clearance is slightly hyperthyroidized, plasma iron conversion rate is normal or slightly elevated, red blood cell iron utilization rate is normal or slightly decreased, and red blood cell survival Time is shortened.

6. Pathological examination: bone marrow metastasis is mostly spread by blood, a small number of lymphatic metastasis, bone marrow biopsy found that the positive rate of bone marrow metastasis is 97%, bone marrow smear is 72%, 1 bone marrow smear: metastatic cancer cell volume Different, often a cluster of multiple cancer cells, visible binuclear or multinuclear, the proportion of nucleoplasm increased, chromatin is dark blue, often nucleoli, cytoplasmic blue, adenocarcinoma cells are arranged in adenoid structure, 2 bone marrow pathological sections: visible metastatic tumor cells and myelofibrosis, metastatic cancer cells mostly aggregated into lumps, flaky, strip-like, similar in morphology to primary malignant cells, from the prostate, breast, gastrointestinal tract The cancer cells are adenoid, rich in cytoplasm and contain secretions. The secretions can be judged by special staining. When squamous cell carcinoma metastasizes, keratinized beads are formed and intercellular bridges are formed. The shape of cancer cells is large and the nucleus is large. The chromatin is rough, dark blue, nucleoli is obvious, the cytoplasmic boundary is unclear, and clear cell carcinoma metastasis is rare.

7. X-ray examination: worm-like defects and bone marrow fibrosis were found in the bone radiograph.

8 radionuclide: bone scan to find metastases.

Diagnosis and diagnosis of bone marrow anemia

Diagnostic criteria

1. There is a primary disease that causes bone marrow infiltration anemia.

2. Symptoms and signs of bone pain, bone destruction and hypercalcemia in one place and multiple places.

3. Anemia with no obvious cause can explain the hepatosplenomegaly.

4. Young blood erythrocyte blood picture.

5. Bone marrow compensatory or "dry pumping", bone marrow puncture or biopsy to find metastatic tumor cells.

6. X-ray examination showed bone destruction.

Differential diagnosis

1. Leukemia-like reaction: the total number of white blood cells increased significantly, exceeding 50×109/L, but there was no change in red blood cells and platelets, and neutrophils of neutrophils and vacuoles were formed in granulocytes, which were transient leukocyte hyperplasia, primary disease. After removal by treatment, the blood picture changes back to normal.

2. Chronic myeloid leukemia (CML): There is a huge spleen, white blood cell count is significantly increased, acidophilic and basophilic granulocytes; neutral alkaline phosphatase (NAP) activity is reduced or even zero, Ph chromosome positive.

3. Iron deficiency anemia (IDA): When the malignant tumor metastasizes to the bone marrow and the primary lesion is not obvious, it can be misdiagnosed as IDA. The cause of failure to find iron deficiency anemia and the small cell hypopigmentation based on laboratory tests for iron deficiency. Anemia, or treatment with iron can only receive temporary effects, should carefully look for the primary lesion.

4. Hemolytic anemia: There is evidence of increased red blood cell destruction and compensatory hyperplasia of the bone marrow, reticulocytes increase, and red blood cells change significantly without granulocyte and platelet changes, and there is no bone pain or bone destruction.

5. Aplastic anemia: no bone pain and liver, spleen lymph node enlargement; no immature red blood cell blood; low bone marrow hyperplasia, non-hematopoietic cells, no bone destruction, no tumor cell infiltration.

6. MDS: generally no hepatic spleen lymph node enlargement, morphological characteristics of abnormal pathological hematopoiesis.

7. Bone marrow infiltrative anemia is not only seen in malignant tumors, but also in severe infections, inflammation, lipid storage diseases, etc.; younger erythroblastemia can also be seen in bone marrow caused by severe blood loss, transient hypoxia, acute infection, etc. Necrosis, etc., in the differential diagnosis, it is necessary to pay great attention to identification.

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