Pediatric Leukemia Reaction

Introduction to pediatric leukemia response The leukemia-like reaction, also known as leukemia-like reaction, refers to the fact that the body is stimulated by certain factors, resulting in a significant increase in the number of white blood cells in the peripheral blood or the appearance of immature cells, much like leukemia rather than leukemia, which is a temporary leukocyte proliferative response. Neutrophils caused by various causes In addition to chronic myeloid leukemia, white blood cell counts generally do not exceed 50 × 109 / L, but occasionally can exceed 50 × 109 / L, or even 100 × 109 / L, while blood neutral The left granulocyte nucleus shift is obvious, and there are more late myelocytes, mesangial cells, and even a small number of promyelocytes and myeloblasts. This phenomenon is similar to that of chronic myeloid leukemia, and thus becomes a leukocyte-like reaction. . It has many types, including granulocyte type, erythroleukemia type, plasma cell type and mixed cell type, among which neutrophil type is the most common. basic knowledge The proportion of illness: 0.003% Susceptible people: children Mode of infection: non-infectious Complications: anemia

Pediatric leukemia response etiology

(1) Causes of the disease

1. The leukemia-like reaction is caused by infection, tumor, ionizing radiation, drug poisoning, trauma, shock, burns, allergies, major bleeding, hemolysis and other factors, and a transient leukemia-like blood reaction occurs. The absorption of infection, toxins and other harmful substances into the blood is the main cause of leukemia-like reactions in children.

1. Infection: The most common, bacteria, viruses, parasites, etc.

2. Poisoning: high heat poisoning, mercury poisoning, food poisoning, eclampsia, etc.

3. Tumor: Hodgkin's disease, tumor with bone metastasis, etc.

4. Drugs: arsenic, antipyretic analgesics, sulfa drugs, adrenaline glucocorticoids, lithium salts, etc.

5. Blood loss, acute blood loss and hemolysis caused by any cause of major bleeding, acute intravascular hemolysis.

6. Injury of craniocerebral trauma, crush syndrome, large area burns, etc.

7. Allergic diseases, exfoliative dermatitis, rubella, allergic pneumonia, etc.

8. In addition, it can also be seen in pulmonary infarction, myocardial infarction, electroshock, ionizing radiation disease, splenectomy and so on.

2. Causes of each type:

(1) granulocyte leukemia reaction: seen in acute bacterial infection, hemolytic anemia, acute blood loss shock, rheumatoid disease, drug poisoning, bone marrow metastasis, etc.

(2) lymphocytic leukemia reaction: seen in whooping cough, tuberculosis, rubella, chickenpox, infectious mononucleosis, infectious lymphocytosis.

(3) Eosinophilic leukemia reaction: seen in parasitic diseases, allergic diseases, collagen vascular diseases, drug reactions, and the like.

(4) Monocytic leukemia response: found in disseminated tuberculosis, rheumatism, brucellosis, intestinal amoebiasis.

(5) erythroleukemia leukemia reaction: seen in severe anemia, benzene poisoning, splenectomy and so on.

(6) plasma cell leukemia reaction: seen in advanced tuberculosis, liver disease.

(two) pathogenesis

It is generally believed that due to the presence of stimulating factors, the body is in a state of high stress, the capillaries and sinusoidal endothelial cells in the bone marrow are damaged, the bone marrow is proliferated, and the pressure in the medullary cavity is increased, causing excessive proliferation and abnormal release of leukocytes, resulting in some immature cells. It is also released into the peripheral blood in a large amount, and a transient leukemia-like blood reaction occurs, which may be a defense reaction produced by a mechanism such as neurohumoral fluid. Pediatric hematopoietic organs are in an immature, unstable state, and are more prone to leukemia-like reactions.

Increased peripheral blood leukocytes or immature cells are abnormalities in cell production or release, which may be accompanied by defects of clearance and destruction. The specific mechanism is inconsistent. The regulation of eosinophils is similar to that of neutrophils. Many factors such as antigen-antibody reaction, exogenous protein parasites can cause eosinophilia, and some tumor cells can also produce colony-stimulating factors to stimulate hematopoietic cell proliferation, differentiation, release of toxins, hypoxia immune response, chemicals. Other factors can damage the capillary endothelial cells of the bone marrow, and the medullary blood barrier is impaired, causing some of the immature cells to enter the blood circulation and develop a leukemia-like reaction. After splenectomy, it may be because the bone marrow loses part of the control effect, so when some external factors stimulate the bone marrow, it is easier to release the young or young red blood cells into the peripheral blood.

Pediatric leukemia reaction prevention

Usually, this disease is caused by severe infection, certain malignant tumors, drug poisoning, massive hemorrhage and hemolysis reaction, which stimulates hematopoietic tissue. Therefore, it is necessary to actively prevent and treat various diseases that cause leukemia-like reactions.

1. Vigorously carry out prevention and treatment of various infectious diseases, especially viral infectious diseases, and do a good job of vaccination.

2. Avoid contact with harmful factors. Avoid contact with harmful chemicals, ionizing radiation and other harmful factors. When contacting poisons or radioactive materials, strengthen various protective measures; avoid environmental pollution, especially indoor environmental pollution; pay attention to rational use of drugs, use cells with caution. Poisonous drugs, etc.

3. Strengthen physical exercise, pay attention to food hygiene, maintain a comfortable mood, combine work and rest, and enhance the body's resistance.

Pediatric leukemia reaction complications Complications anemia

According to the original disease, the corresponding complications appear. Common complications include secondary infection, fever, liver and spleen, swollen lymph nodes, and anemia.

Pediatric leukemia reaction symptoms common symptoms leukocytosis lymph node enlargement hepatomegaly splenomegaly

Clinical manifestation

Children are more common, with the same incidence of men and women. Because the leukemia-like response is secondary to other diseases, there is no specific clinical manifestation. The symptoms and signs vary depending on the primary disease. Fever is more common, and there may be bleeding symptoms such as mild liver, spleen, swollen lymph nodes and skin spots.

2. Clinical classification

Clinical types can be divided into 6 types according to the increased reactivity of cells:

(1) granulocyte leukemia reaction: the total number of white blood cells can reach 50×109/L or more. Mainly neutrophils, can be associated with a certain number of naive cells. In the cytoplasm of mature neutrophils, toxic granules and vacuoles appeared. In addition to hyperplasia and left shift, the neutrophil alkaline phosphatase score of mature neutrophils was significantly increased. Found in infection, blood loss, poisoning, etc.

(2) Lymphocytic leukemia reaction: The white blood cell count is mild or significantly increased, and mature lymphocytes account for more than 40% in the classification, and there may be naive lymphocytes. Found in infections, allergic diseases, etc.

(3) eosinophilic leukemia reaction: eosinophils in peripheral blood showed an increase, no naive cells; bone marrow like primitive cells, no ph chromosome and eosinophil morphology abnormalities. Common in infections, allergic diseases, drug reactions, etc.

(4) Monocytic leukemia reaction: the white blood cell count is above 30×10 9th power/L, and the monocyte is >30%. Found in infections, etc.

(5) erythroleukemia leukemia reaction: there are young red and young cells in the peripheral blood, bone marrow granulosa cell line hyperplasia, erythroid cell proliferation is seen in poisoning, splenectomy and so on.

(6) plasma cell leukemia reaction: white blood cells increased, the plasma cell counts in peripheral blood increased, often > 5%, neutrophils left shift, mononuclear cells increased, bone marrow like the plasma cell system is active, but generally <20%, a small amount of young plasma cells, even pure plasma cells can be seen. Found in infections, etc.

Examination of pediatric leukemia response

1. Blood: Hemoglobin is normal or slightly reduced. The platelet count was normal. The white blood cell count is generally between (50 and 100) x 109 / L. In leukemia-like patients with tuberculosis, there are reports of leukocytes up to 220 × 109 / L. There are different types of leukemia-like reactions depending on the body's stimulating factors, which may be the ratio of granulocytes, monocytes, lymphocytes or eosinophils. Increase. Immature cells are visible in the classification, and toxic particles and vacuoles often appear in the cytoplasm of neutrophils.

2. Bone marrow: visible toxicity in the infection, but also normal. It may be hyperplastic or mildly active, often with a series of hyperplasia, most of which are mainly mature cells, or may have left nucleus or maturation disorders, and there is no obvious increase in primordial cells. Generally, there is no Auer corpuscle and no leukemia. Abnormal cell morphology. The erythroid and megakaryocytes are normal. Cancerous bone marrow metastasis-like leukemia reactions can also be seen in varying numbers of cancer cells.

3. Bone marrow histopathology: sinusoidal blood vessels are normal or slightly increased, often with false Gaucher cells, mast cells can easily see iron-containing granule macrophages can be significantly increased, fat cells are abnormally distributed, most of which are distributed along the trabecular bone.

4. Cytochemical staining: normal or elevated neutrophil alkaline phosphatase score. Tetrazolium blue staining was significantly increased in response to infectious leukemia. Leukemia-like reactions are negative for Philadelphia (ph) chromosomes, whereas chronic myeloid leukemia is seen in more than 90% of patients.

5. Genetic examination: no ph1 chromosome. According to the needs of the primary disease, choose an auxiliary examination, such as chest X-ray, B-ultrasound, electrocardiogram and so on.

6. Imaging examination: X-ray tuberculosis patients with X-rays suggest tuberculosis, chest infections can be prompted. B super liver and spleen, swollen lymph nodes.

Diagnosis and diagnosis of pediatric leukemia response

diagnosis

Diagnosis can be based on the cause, symptoms and related tests.

Differential diagnosis

Generally, it can be distinguished from leukemia according to medical history, clinical manifestations and cell morphology. It is difficult to distinguish between patients with lymphadenopathy, splenomegaly, fever or hemorrhage and leukemia.

Leukemia is a malignant disease of hematopoietic tissue, also known as "blood cancer." It is characterized by a large number of leukemia cells in bone marrow and other hematopoietic tissues that proliferate without restriction and enter the peripheral blood, while the production of normal blood cells is significantly inhibited, divided into acute and chronic categories. Often bleeding, anemia, infection, liver and spleen lymph nodes and other symptoms, it is generally difficult to cure.

The main manifestations are the proliferation and infiltration of leukemia cells. Non-specific lesions are hemorrhage and tissue malnutrition and necrosis, secondary infections, and the like. The proliferation and infiltration of leukemia cells mainly occur in bone marrow and other hematopoietic tissues, and can also occur in other tissues of the body, resulting in a significant decrease in normal erythroid cells and megakaryocytes. In the bone marrow, some leukemia cells may be active or extremely active, but may be grayish red or yellowish green. Lymphoid tissue can also be infiltrated by leukemia cells, and lymph nodes are enlarged later.

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