Symptom >> Internal Medicine >> Hematology

Left shift of bone marrow

Introduction
Cause
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Diagnosis

Introduction

Introduction The phenomenon of left bone shift in the bone marrow is the manifestation of basophilic leukemia. For example, a large number of basophils can be seen in the bone marrow, and the original cells are >5%. The basophilic young and late granulocytes also increased, and there was a nuclear left shift phenomenon, and the cytoplasm had coarse basophilic particles.

Cause

Cause

Bone marrow shifting to the left is a manifestation of basophilic leukemia, the cause of basophilic leukemia:

The cause is unknown. Most patients with basophilic leukemia are from the chronic phase of chronic myeloid leukemia (CML), but acute basophilic leukemia can also occur, but does not contain the Philadelphia chromosome.

Pathogenesis of basophilic leukemia:

Some patients with acute granulocyte and monocytic leukemia have t(6;9)(p23;q34) abnormalities. The basophils in the bone marrow increase, but there is no increase in peripheral blood, while patients with CML have t(9;22 (q34; q11) abnormalities, both diseases have abnormal chromosome 9 (q34), and there are increased basophils, which indicates that chromosome 9 breakpoint genes may affect basophils produce. Peterson et al. performed ultrastructural analysis of 455 leukemia blasts in patients with acute leukemia and found 8 cases of acute basophilic leukemia, accounting for less than 2% of acute leukemia. However, Quattrin counted 2,152 cases of hematological malignancies admitted to the Naples Hospital in Italy from 1959 to 1973, accounting for 4.5% of acute leukemia. The disease is immature basophils in the blood (more than 1/3 of the total number of white blood cells) and persists throughout the disease.

Examine

an examination

Related inspection

Bone marrow imaging analysis of bone marrow imaging

The left-shift phenomenon of bone marrow is a manifestation of basophilic leukemia. The domestic diagnostic criteria for basophilic leukemia are as follows:

1. Clinically, there is leukemia.

2. The basophils in the peripheral blood increased significantly.

3. Bone marrow

A large number of basophils were seen, with primordial cells >5%. The basophilic young and late granulocytes also increased, and there was a nuclear left shift phenomenon, and the cytoplasm had coarse basophilic particles.

4. Organs have basophilic infiltration.

5. Absence of basophilia due to other causes.

Diagnosis

Differential diagnosis

Bone marrow image change: refers to the phenomenon of bone marrow cell proliferation, bone marrow cell count, redness ratio, and the proportion of hematopoietic cells in various systems and stages.

Bone marrow damage: Osteomyelitis is a bone infection and destruction. Caused by aerobic or anaerobic bacteria, mycobacteria, fungi. Osteomyelitis occurs in the vertebrae, in the feet of diabetic patients, or in areas of penetrating bone damage caused by trauma or surgery. The most common site for children is long bones with good blood supply (such as the metaphysis of the tibia or femur). Bone infection and vascular occlusion can cause osteonecrosis and local infection spread. The infection can spread through the cortical bone to the subperiosteum and form a subcutaneous abscess. The latter spontaneously penetrates the skin for drainage.

Bone marrow dysplasia: The most common disease is myelodysplastic syndrome (MDS), a group of heterogeneous clonal disorders that originate from hematopoietic myeloid stem cells or pluripotent stem cells. Crohn's hematopoietic stem and dysplasia, leading to inefficient hematopoiesis and increased risk of malignant transformation. The main features are ineffective hematopoiesis and high-risk evolution to acute myeloid leukemia. The clinical manifestations are abnormal changes in the quality and quantity of hematopoietic cells. The incidence of MDS is about 10/10 million to 12/100,000 people, mostly involving middle-aged and elderly people, 50% to 70% of cases over 50 years old, and the ratio of male to female is 2:1. MDS 30% to 60% is converted to leukemia. In addition to leukemia, most of the causes of death are due to infection, bleeding, and especially intracranial hemorrhage.