Anisocytosis: txhais, tsos mob thiab kev kho mob

Anisocytosis yog lo lus siv hauv hematology thaum muaj qhov txawv txav me me ntawm cov qe ntshav ntawm tib kab kab xws li:

• cov ntshav liab, tseem hu ua cov qe ntshav liab lossis erythrocytes;
• ntshav platelets, tseem hu ua thrombocytes.

Nws tuaj yeem cais qhov sib txawv ntawm anisocytoses nyob ntawm kab xov tooj ntawm tes txhawj xeeb:

• erythrocyte anisocytosis thaum qhov txawv txav txhawj xeeb txog erythrocytes (cov qe ntshav liab);
• platelet anisocytosis kev kho mob, qee zaum hu ua thrombocytic anisocytosis, thaum qhov txawv txav cuam tshuam txog thrombocytes (ntshav platelets).

Nyob ntawm hom kev txawv txav pom, anisocytosis qee zaum txhais raws li:

• anisocytosis, feem ntau sau luv ua microcytosis, thaum cov qe ntshav me me txawv txav;
• aniso-macrocytosis cov tsos mob, feem ntau sau luv ua macrocytosis, thaum cov ntshav cov ntshav txawv txav ntau.

Anisocytosis yog ntshav txawv txav qhia thaum lub sijhawm hemogram duab, tseem hu ua Blood Count and Formula (NFS). Nqa tawm los ntawm kev kuaj ntshav ntshav, qhov kev tshuaj xyuas no muab cov ntaub ntawv ntau ntawm cov qe ntshav.

Ntawm cov txiaj ntsig tau txais thaum suav ntshav, cov ntshav faib cov qe liab faib (RDI) kuj tseem hu ua anisocytosis index. Ua kom nws tuaj yeem ntsuas qhov kev hloov pauv ntawm qhov loj ntawm cov qe ntshav liab hauv cov ntshav, qhov ntsuas no ua rau nws tuaj yeem txheeb xyuas erythrocyte anisocytosis. Nws suav tias yog ib txwm thaum nws nyob nruab nrab ntawm 11 txog 15%.

Feem ntau hais lus, anisocytosis yog lo lus siv los ntawm kws kho mob hais txog erythrocyte anisocytosis. Hais txog cov qe ntshav liab, cov ntshav txawv txav no feem ntau yog vim anemia, qhov txawv txav hauv qib ntawm cov qe ntshav liab lossis hemoglobin hauv cov ntshav. Qhov tsis txaus no tuaj yeem ua rau muaj teeb meem vim tias cov qe ntshav liab yog cov cell tseem ceeb rau kev faib cov pa oxygen hauv lub cev. Tam sim no hauv cov qe ntshav liab, hemoglobin yog cov protein uas muaj peev xwm khi tau ntau cov molecules ntawm cov pa (O2) thiab tso rau hauv cov hlwb.

Nws tuaj yeem paub qhov txawv ntawm ntau hom mob ntshav qab zib ua rau erythrocyte anisocytosis, suav nrog:

• lubhlau tsis muaj zog, tshwm sim los ntawm cov hlau tsis txaus, uas suav tias yog microcytic anemia vim nws tuaj yeem ua rau anisocytosis nrog kev tsim cov qe ntshav liab me me;
• vitamin deficiency anemia, feem ntau ntawm cov uas yog vitamin B12 deficiency anemias thiab vitamin B9 deficiency anemias, uas suav tias yog macrocytic anemias vim tias lawv tuaj yeem ua rau aniso-macrocytosis nrog kev tsim cov qe ntshav liab loj deformed.
• lubhemolytic anemia, tshwj xeeb los ntawm kev puas tsuaj ua ntej ntawm cov qe ntshav liab, uas tuaj yeem tshwm sim los ntawm kev tshuaj ntsuam genetic txawv txav lossis kab mob.

Platelet anisocytosis kuj muaj keeb kwm keeb kwm. Platelet anisocytosis tuaj yeem yog vim yog myelodysplastic syndromes (MDS), uas yog cov txheej txheem kab mob vim ua haujlwm tsis zoo ntawm cov pob txha.

Tej yam tshwj xeeb ntawm anisocytosis

Physiological

Tsis yog ib txwm muaj anisocytosis qhia tau hais tias muaj kab mob. Piv txwv li, nyob rau hauv cov me nyuam mos, physiological macrocytosis tau pom. Qhov no yog vim qhov maj mam loj hlob ntawm cov pob txha pob txha thiab cov txheej txheem ntawm mitosis hauv hematopoietic qia hlwb. Los ntawm lub hli thib 2 ntawm lub neej, anisocytosis maj mam daws nws tus kheej.

hlau tsis muaj peev xwm

Feem ntau pathological ua rau anisocytosis yog hlau deficiency. Nrog ib tug tsis muaj hlau nyob rau hauv lub cev, muaj ib tug ua txhaum ntawm maturation ntawm erythrocytes, tsim ntawm lawv cell membrane, thiab tsim hemoglobin. Yog li ntawd, qhov loj ntawm cov qe ntshav liab txo qis (microcytosis). Nrog rau qhov tsis muaj hlau tsis txaus, tag nrho cov ntsiab lus ntawm hemoglobin hauv cov ntshav txo qis, thiab cov hlau tsis muaj hlau tsis txaus (IDA) tshwm sim.

Ua ke nrog anisocytosis, hypochromia feem ntau tshwm sim, piv txwv li txo hemoglobin saturation ntawm erythrocytes. Anisocytosis, nrog rau lwm yam kev hloov pauv hauv erythrocyte indices (MCV, MCH, MCHC), tuaj yeem ua ntej kev loj hlob ntawm IDA, nyob rau hauv lub npe hu ua latent iron deficiency.

Tsis tas li ntawd, anisocytosis tuaj yeem tshwm sim thaum pib ntawm cov hlau ntxiv rau kev kho mob ntawm cov hlau deficiency anemia. Tsis tas li ntawd, nws muaj cov cim tshwj xeeb - muaj coob tus ntawm ob qho tib si microcytes thiab macrocytes hauv cov ntshav, uas yog vim li cas lub histogram ntawm kev faib tawm ntawm erythrocytes muaj cov yam ntxwv ntawm ob lub ncov zoo li.

Ua rau muaj hlau tsis txaus:

• Khoom noj khoom haus.
• Thaum yau, hluas, cev xeeb tub (lub sijhawm xav tau hlau ntxiv).
• Profuse ncua kev coj khaub ncaws.
• Cov ntshav poob qis: peptic ulcer ntawm lub plab lossis duodenum, hemorrhoids, hemorrhagic diathesis.
• Cov mob tom qab resection ntawm lub plab los yog cov hnyuv.
• Kev mob caj ces ntawm cov hlau metabolism: keeb kwm atransferrinemia.

Kev kuaj ntshav rau kev tshawb fawb

Vitamin B12 thiab folic acid deficiency

Lwm qhov ua rau anisocytosis, uas yog macrocytosis, yog B12 deficiency nrog folic acid, thiab kev sib koom ua ke ntawm cov vitamin deficiency feem ntau pom. Qhov no yog vim lawv qhov tshwm sim ze ntawm cov tshuaj metabolic. Qhov tsis muaj B12 tiv thaiv kev hloov pauv ntawm folic acid mus rau hauv daim ntawv nquag, coenzyme. Qhov tshwm sim biochemical no hu ua folate trap.

Qhov tsis muaj cov vitamins no ua rau muaj kev ua txhaum ntawm purine thiab pyrimidine hauv paus (cov khoom tseem ceeb ntawm DNA), uas feem ntau cuam tshuam rau kev ua haujlwm ntawm cov pob txha pob txha, raws li lub cev nrog cov haujlwm siab tshaj plaws ntawm kev loj hlob ntawm tes. Ib hom megaloblastic ntawm hematopoiesis tshwm sim - tsis tag nrho cov hlwb nrog cov ntsiab lus ntawm cov cell nucleus, nce saturation ntawm hemoglobin thiab nce loj nkag mus rau hauv cov ntshav peripheral, piv txwv li anemia yog macrocytic thiab hyperchromic nyob rau hauv cov xwm.

Cov laj thawj tseem ceeb ntawm B12 deficiency:

• Kev noj zaub mov nruj thiab tsis suav nrog cov khoom tsiaj.
• atrophic gastritis.
• autoimmune gastritis.
• Resection ntawm lub plab.
• Hereditary deficiency ntawm intrinsic factor Castle.
• Malabsorption : kab mob celiac, inflammatory plob tsis so tswj kab mob.
• Kab mob kab mob: diphyllobothriasis.
• Genetic defect ntawm transcobalamin.

Txawm li cas los xij, cais folate deficiency tuaj yeem tshwm sim. Hauv cov xwm txheej zoo li no, tsuas yog kev hloov pauv pathological hauv cov ntshav tuaj yeem yog anisocytosis (macrocytosis). Qhov no feem ntau pom nyob rau hauv cawv, vim ethyl cawv slows qhov nqus ntawm folate nyob rau hauv lub plab zom mov. Tsis tas li ntawd, qhov tsis muaj folic acid thiab tom qab macrocytosis tshwm sim hauv cov neeg mob uas siv cov tshuaj tiv thaiv qhov ncauj ntev ntev, hauv cov poj niam cev xeeb tub.

Thalassemia

Qee zaum, anisocytosis (microcytosis), nrog rau hypochromia, tej zaum yuav yog cov cim qhia ntawm thalassemia, ib pawg ntawm cov kab mob uas tshwm sim los ntawm caj ces txawv txav hauv kev sib txuas ntawm globin chains. Raws li kev hloov pauv ntawm cov noob caj noob ces, tsis muaj qee qhov globin chains thiab ntau dhau ntawm lwm tus (alpha, beta lossis gamma chains). Vim muaj qhov tsis zoo hemoglobin molecules, cov qe ntshav liab txo qhov loj me (microcytosis), thiab lawv daim nyias nyias yuav raug puas tsuaj ntau dua (hemolysis).

Cov kab mob microspherocytosis

Hauv Minkowski-Choffard tus kab mob, vim muaj kev hloov pauv ntawm cov noob encoding tsim cov txheej txheem ntawm cov proteins ntawm erythrocyte daim nyias nyias, permeability ntawm lawv cov phab ntsa ntawm tes nce hauv cov qe ntshav liab, thiab dej accumulates hauv lawv. Erythrocytes txo qhov loj me thiab ua kheej kheej (microspherocytes). Anisocytosis nyob rau hauv tus kab mob no feem ntau ua ke nrog poikilocytosis.

Sideroblastic anemias

Tsis tshua muaj, anisocytosis tej zaum yuav yog vim muaj cov kab mob sideroblastic anemia, kab mob pathological uas siv cov hlau tsis zoo, thaum cov ntsiab lus hlau hauv lub cev yuav zoo li qub lossis nce siab. Ua rau ntawm sideroblastic anemia:

• Myelodysplastic syndrome (feem ntau yog vim li cas).
• Noj cov tshuaj uas cuam tshuam cov metabolism ntawm vitamin B6.
• Cov kab mob ua npaws ntev.
• Kev hloov pauv ntawm ALAS2 noob.

diagnostics

Kev kuaj pom ntawm qhov xaus "anisocytosis" hauv daim ntawv ntawm kev kuaj ntshav yuav tsum tau rov hais dua tus kws kho mob los txiav txim qhov ua rau ntawm tus mob no. Thaum lub sij hawm teem tseg, tus kws kho mob sau cov ncauj lus kom ntxaws keeb kwm, qhia txog qhov muaj kev tsis txaus siab ntawm cov yam ntxwv ntawm anemia (kev qaug zog, kiv taub hau, deterioration hauv concentration, thiab lwm yam). Qhia meej seb tus neeg mob puas noj cov tshuaj tsis tu ncua.

Thaum lub hom phiaj kev kuaj mob, kev saib xyuas yog coj mus rau lub xub ntiag ntawm cov tsos mob ntawm anemic syndrome: pallor ntawm daim tawv nqaij thiab mucous daim nyias nyias, tsis tshua muaj ntshav siab, nce plawv dhia, thiab lwm yam. Rau hereditary hemolytic anemia, muaj cov tsos mob ntawm deformation ntawm cov pob txha. skeleton yog yam ntxwv.

Cov kev tshawb fawb ntxiv tau teem tseg:

• Kev soj ntsuam ntshav dav dav. Hauv KLA, qhov taw qhia ntawm hematological analyzer, uas qhia txog qhov muaj anisocytosis, yog RDW. Txawm li cas los xij, nws yuav ua yuam kev siab vim muaj cov kab mob agglutinins txias. Yog li ntawd, ib qho kev soj ntsuam microscopic ntawm cov ntshav smear yog qhov yuav tsum tau ua. Tsis tas li, kev tshuaj ntsuam xyuas tuaj yeem kuaj pom cov tsos mob ntawm B12 tsis txaus (Jolly lub cev, Kebot rings, hypersegmentation ntawm neutrophils) thiab lwm yam kab mob suav nrog (basophilic granularity, Pappenheimer lub cev).
• Ntshav chemistry. Hauv kev kuaj ntshav biochemical, qib ntawm cov piam thaj hlau, ferritin, thiab transferrin raug kuaj. Cov cim ntawm hemolysis kuj tseem yuav raug sau tseg - qhov nce hauv cov concentration ntawm lactate dehydrogenase thiab indirect bilirubin.
• Kev tshawb fawb txog kev tiv thaiv kab mob. Yog tias xav tias muaj kab mob autoimmune ntawm lub plab hnyuv siab raum, kev ntsuam xyuas tau ua rau cov tshuaj tiv thaiv kab mob rau lub plab parietal, cov tshuaj tiv thaiv rau transglutaminase, thiab gliadin.
• Kev kuaj pom qhov txawv txav hemoglobin. Hauv kev kuaj mob ntawm thalassemia, hemoglobin electrophoresis ntawm cellulose acetate zaj duab xis lossis kev ua haujlwm siab ua kua chromatography yog ua.
• Kev kuaj mob ntawm microspherocytosis. Txhawm rau kom paub meej lossis tsis suav nrog cov keeb kwm ntawm microspherocytosis, osmotic tsis kam ntawm erythrocytes thiab EMA kuaj yog ua los ntawm kev siv cov tshuaj fluorescent eosin-5-maleimide.
• Kev tshawb fawb parasitological. Nyob rau hauv cov ntaub ntawv ntawm suspicion ntawm diphyllobothriasis, microscopy ntawm ib haiv neeg fecal npaj yog muab los mus nrhiav cov qe ntawm ib tug dav tapeworm.

Qee zaum nws yuav tsum tau ua qhov kev kuaj mob sib txawv ntawm IDA thiab thalassemia me. Qhov no tuaj yeem ua tiav los ntawm kev kuaj ntshav dav dav. Rau qhov no, Mentzer index yog xam. Qhov piv ntawm MCV rau cov qe ntshav liab ntau dua 13 yog ib qho zoo rau IDA, tsawg dua 13 - rau thalassemia.

Kev kuaj ntshav smear

Cov tsos mob ntawm anisocytosis yog cov ntshav tsis txaus. Txawm hais tias muaj cov ntawv sib txawv thiab keeb kwm ntawm ntshav tsis txaus, ntau tus yam ntxwv tus cwj pwm tau nquag pom:

• kev xav ntawm kev qaug zog dav dav;
• ua tsis taus pa
• palpitations;
• qaug zog thiab kiv taub hau;
• pallor;
• mob taub hau.

Kev kho rau anisocytosis nyob ntawm qhov ua rau muaj qhov txawv txav. Thaum muaj cov hlau tsis muaj ntshav tsis txaus lossis tsis muaj vitamin tsis txaus ntshav, piv txwv li kev noj zaub mov ntxiv tuaj yeem pom zoo kom kho anisocytosis.