Anisocytosis: tsananguro, zviratidzo uye kurapwa

Anisocytosis izwi rinoshandiswa mu hematology kana paine saizi isina kujairika pakati pemasero eropa eiyo imwechete sero mutsara senge:

• masero matsvuku eropa, inonziwo masero matsvuku eropa kana erythrocyte;
• maplatelet eropa, inonziwo thrombocyte.

Izvo zvinokwanisika kusiyanisa akati wandei anisocytoses zvichienderana nesero mutsara unetsekana:

• erythrocyte anisocytosis kana iko kusanzwisisika kuchinetsa erythrocyte (masero matsvuku eropa);
• platelet anisocytosis, dzimwe nguva inonzi thrombocytic anisocytosis, kana iko kusanzwisisika kuchinetsa nezve thrombocyte (maplatelet eropa).

Zvichienderana nerudzi rwekusaziva kunowanikwa, anisocytosis dzimwe nguva inotsanangurwa se:

• anocoshtosis, kazhinji inopfupikiswa se microcytosis, apo masero eropa ari madiki zvisina kujairika;
• aniso-macrocytosis, inowanzo kupfupikiswa se macrocytosis, apo masero eropa akakura zvisina kujairika.

Anisocytosis ndeyekusarongeka kweropa kunoonekwa panguva ye hemogram, inonziwo Ropa Kuverenga uye Fomura (NFS). Inoitwa nekutora muyero weropa rine huturu, iyi ongororo inopa yakawanda data pamusoro pemasero eropa.

Pakati pehunhu hunowanikwa panguva yekuverengwa kweropa, iyo tsvuku sero rekuparadzira index (RDI) inonziwo anisocytosis index. Kuita kuti zvikwanisike kuongorora kusiyanisa muhukuru hwemasero matsvuku eropa muropa, iyi index inoita kuti ikwanise kuziva erythrocyte anisocytosis. Inoonekwa seyakajairika kana iri pakati pegumi neshanu muzana.

Kazhinji kutaura, anisocytosis izwi rinoshandiswa navanachiremba kureva erythrocyte anisocytosis. Nezve masero matsvuku eropa, iko kusarongeka kweropa uku kunowanzo kuve nekuda kwe anemia, kudonha kusingaenzanisike pachiyero chemasero matsvuku eropa kana hemoglobin muropa. Uku kushomeka kunogona kukonzeresa nekuti masero matsvuku eropa ndiwo masero akakosha pakugovaniswa kweoksijeni mukati memuviri. Parizvino mumasero matsvuku eropa, hemoglobin ipuroteni inokwanisa kusunga mamorekuru mazhinji eoksijeni (O2) nekuasunungura mumasero.

Izvo zvinokwanisika kusiyanisa akati wandei marudzi eanemia anokonzera erythrocyte anisocytosis, kusanganisira:

• ariiron kushomeka kupererwa neropa, inokonzerwa nekushomeka kwesimbi, iyo inonzi microcytic anemia nekuti inogona kutungamira kune anisocytosis nekuumbwa kwemasero matsvuku eropa;
• vhitamini kushomeka kupererwa neropa, ayo akajairika ayo mavitamini B12 kushomeka anemias uye vhitamini B9 kushomeka anemias, ayo anonzi macrocytic anemias nekuti anogona kukonzera aniso-macrocytosis nekugadzirwa kwemasero matsvuku eropa akaremara.
• arihemolytic kupererwa neropa, inoratidzirwa nekukurumidza kuparadzwa kwemasero matsvuku eropa, ayo anogona kukonzerwa nemagene asina kujairika kana chirwere.

Platelet anisocytosis zvakare ine hutachiona hutangira. Platelet anisocytosis inogona kunyanya kuve nekuda kweiyo myelodysplastic syndromes (MDS), iyo inoumba seti yezvirwere nekuda kwekushomeka kwemongo wemapfupa.

Zvimwe Zvikonzero zve anisocytosis

Physiological

Kwete nguva dzose kuvapo kweanisocytosis kunoratidza chero chirwere. Semuenzaniso, muvana vachangoberekwa, physiological macrocytosis inoonekwa. Izvi zvinokonzerwa nekukura zvishoma nezvishoma kwemwongo uye maitiro e mitosis mumasero eropa rehematopoietic. Pakazosvika mwedzi wechipiri wehupenyu, anisocytosis inogadzirisa pachayo zvishoma nezvishoma.

kutadza kwesimbi

Chinonyanya kukonzera pathological anisocytosis kushaikwa kwesimbi. Nekushaikwa kwesimbi mumuviri, pane kukanganisa kwekukura kwe erythrocytes, kuumbwa kwesero membrane yavo, uye kuumbwa kwehemoglobin. Somugumisiro, kukura kwemasero matsvuku eropa kunoderera (microcytosis). Nekushaikwa kwesimbi, iyo yakazara hemoglobin muropa inoderera, uye iron inoshaya anemia (IDA) inokura.

Pamwe chete neanisocytosis, hypochromia inowanzoitika, kureva kuderedza hemoglobin saturation ye erythrocytes. Anisocytosis, pamwe chete nedzimwe shanduko mu erythrocyte indices (MCV, MCH, MCHC), inogona kutangira kukura kweIDA, mune iyo inonzi latent iron deficiency.

Zvakare, anisocytosis inogona kuramba ichienderera pakutanga kwesimbi yekuwedzera kurapa kushaya iron anemia. Uyezve, ine hunhu hwakanyanya - kune huwandu hukuru hwezvose microcytes uye macrocytes muropa, ndicho chikonzero histogram yekugovera erythrocytes ine hunhu huviri-peak chitarisiko.

Zvikonzero zvekushaya iron:

• Alimentary factor.
• Uduku, kuyaruka, pamuviri (nguva dzekuwedzera kudiwa kwesimbi).
• Kuenda kumwedzi kwakanyanyisa.
• Kurasikirwa kweropa kwenguva refu: peptic ulcer yemudumbu kana duodenum, hemorrhoids, hemorrhagic diathesis.
• Mamiriro mushure mekubviswa kwedumbu kana matumbo.
• Genetic kusagadzikana kwesimbi metabolism: nhaka atransferrinemia.

Ropa sampling yetsvakurudzo

Vitamin B12 uye folic acid kushomeka

Chimwe chikonzero cheanisocytosis, iyo macrocytosis, kushayikwa kweB12 nefolic acid, uye kushaikwa kwevhitamini yakabatana kunowanzoonekwa. Izvi zvinokonzerwa nekusawirirana kwavo kwemetabolism. Kushaikwa kweB12 kunodzivirira shanduko yefolic acid kuita inoshanda, coenzyme fomu. Iyi biochemical phenomenon inonzi folate trap.

Kushaikwa kwemavhithamini aya kunotungamirira kuputsa kwepurine uye pyrimidine nheyo (iyo huru zvikamu zveDNA), iyo inonyanya kukanganisa basa remapfupa emapfupa, senhengo ine basa guru rekuwedzera kwesero. A megaloblastic mhando yehematopoiesis inomuka - kwete masero akakura zvakakwana ane zvinhu zvesero nucleus, kuwedzera kuzara kwe hemoglobin uye kuwedzera kukura kupinda muropa reperipheral, kureva kuti anemia ndeye macrocytic uye hyperchromic muzvisikwa.

Zvikonzero zvikuru zvekushomeka kweB12:

• Kudya kwakasimba uye kusabatanidzwa kwezvigadzirwa zvemhuka.
• atrophic gastritis.
• Autoimmune gastritis.
• Kubviswa kwedumbu.
• Nhaka kushomeka kweiyo intrinsic factor Castle.
• Malabsorption : celiac chirwere, kuzvimba bowel chirwere.
• Kubatwa nehonye: diphyllobothriasis.
• Genetic defect ye transcobalamin.

Zvisinei, kushayikwa kwefolate kwakasiyana kunogona kuitika. Mumamiriro ezvinhu akadaro, kuchinja kwepathological muropa kunogona kuva anisocytosis (macrocytosis). Izvi zvinonyanya kuwanikwa mukudhakwa, sezvo ethyl doro inononoka kutorwa kwefolate mudumbu redumbu. Uyewo, kushayikwa kwefolic acid uye macrocytosis inotevera kunoitika kune varwere vanotora mishonga yekudzivirira pamuviri kwenguva yakareba, muvakadzi vane pamuviri.

Thalassemia

Mune zvimwe zviitiko, anisocytosis (microcytosis), pamwe chete ne hypochromia, inogona kuva zviratidzo zvethalassemia, boka rezvirwere zvinoratidzirwa nekusagadzikana kwemajini mukuumbwa kwecheni dzeglobin. Zvichienderana nekuchinja kweimwe gene, pane kushomeka kwemamwe maketani eglobin uye kuwanda kwevamwe (alpha, beta kana gamma cheni). Nekuda kwekuvapo kwemamorekuru ehemoglobin akaremara, masero matsvuku eropa anoderera muhukuru (microcytosis), uye membrane yavo inonyanya kuparadzwa (hemolysis).

Hereditary microspherocytosis

Muchirwere cheMinkowski-Choffard, nekuda kwekuchinja kwejini encoding kuumbwa kwemaitiro eprotein erythrocyte membrane, kupera kwesero ravo rusvingo kunowedzera mumasero matsvuku eropa, uye mvura inoungana mairi. Erythrocytes inoderera muhukuru uye inova spherical (microspherocytes). Anisocytosis muchirwere ichi inowanzobatanidzwa ne poikilocytosis.

Sideroblastic anemias

Kashoma, anisocytosis inogona kukonzerwa nekuvapo kwe sideroblastic anemia, chirwere chechirwere umo kushandiswa kwesimbi kunokanganiswa, nepo iron iri mumuviri inogona kunge yakajairwa kana kukwidziridzwa. Zvikonzero zve sideroblastic anemia:

• Myelodysplastic syndrome (inonyanya kukonzera).
• Kutora mishonga inovhiringidza metabolism ye vitamini B6.
• Kugara kudhakwa kwemutobvu.
• Kuchinja kweiyo ALAS2 gene.

Diagnostics

Kuonekwa kwemhedziso "anisocytosis" nenzira yekuongorora ropa kunoda kukwidza chiremba mukuru kuziva chikonzero chechirwere ichi. Pakugadzwa, chiremba anounganidza nhoroondo yakadzama, anoratidza kuvapo kwekunyunyuta hunhu hweanemia (kusakwana kwese, dzungu, kuderera kwekusagadzikana, nezvimwewo). Inojekesa kana murwere ari kutora chero mishonga nguva dzose.

Panguva yekuongorora chinangwa, kutarisa kunokweverwa kuvapo kwekliniki zviratidzo zveanemic syndrome: pallor yeganda uye mucous membranes, kuderera kweropa, kuwedzera kwemwoyo, etc. For hereditary hemolytic anemia, kuvapo kwezviratidzo zvekushanduka kwebhonzo. skeleton ine hunhu.

Zvimwe zvidzidzo zvakarongwa:

• Kuongororwa kweropa kwakawanda. MuKLA, chiratidzo cheiyo hematological analyzer, inoratidza kuvepo kweanisocytosis, RDW. Nekudaro, inogona kunge yakakwira zvisirizvo nekuda kwekuvapo kwekutonhora kweagglutinins. Nokudaro, kuongorora microscopic yeropa smear inosungirwa. Zvakare, microscope inogona kuona zviratidzo zveB12 kushomeka (Jolly miviri, Kebot mhete, hypersegmentation yeutrophils) uye mamwe pathological inclusions (basophilic granularity, Pappenheimer miviri).
• Ropa kemisitiri. Mukuongororwa kweropa rebiochemical, chiyero che serum iron, ferritin, uye transferrin inotariswa. Zviratidzo zvehemolysis zvinogonawo kuonekwa - kuwedzera kwehuwandu hwe lactate dehydrogenase uye bilirubin isina kunanga.
• Immunological research. Kana chirwere che autoimmune chemuviri wepamuviri chinofungidzirwa, kuongororwa kunoitwa kune masoja ekudzivirira emuviri kumasero emudumbu emudumbu, ma antibodies ku transglutaminase, uye gliadin.
• Kuonekwa kweabnormal hemoglobin. Mukuongororwa kwethalassemia, hemoglobin electrophoresis pa cellulose acetate firimu kana high performance liquid chromatography inoitwa.
• Kuongororwa kwe microspherocytosis. Kusimbisa kana kusabvisa nhaka yemicrospherocytosis, kuramba kweosmotic kwe erythrocytes uye bvunzo yeEMA inoitwa pachishandiswa fluorescent dye eosin-5-maleimide.
• parasitological research. Muchiitiko chekufungira diphyllobothriasis, microscopy yekuzvarwa fecal gadziriro inorongerwa kutsvaga mazai etapeworm yakakura.

Dzimwe nguva zvinodikanwa kuita musiyano pakati peIDA uye thalassemia diki. Izvi zvinogona kuitwa kare nekuongororwa kweropa. Nokuda kweizvi, iyo Mentzer index inoverengwa. Chiyero cheMCV kune nhamba yemasero matsvuku eropa anopfuura gumi nematatu inowanzoitika kuIDA, isingasviki gumi nematatu - yethalassemia.

Kuongorora ropa smear

Zviratidzo zveanisocytosis ndezve zvekushaya ropa. Kunyangwe paine akasiyana mafomu uye kwakatangira kupererwa neropa, akati wandei echiratidzo zviratidzo anowanzoonekwa.

• kunzwa kwekuneta kwakawanda;
• kukurumidza kufema
• palpitations;
• kushaya simba uye dzungu;
• pallor;
• kutemwa nemusoro.

Kurapa kweanisocytosis kunoenderana nechikonzero chekukanganisa. Kana zvikaitika kushomeka kwesimbi anemia kana vhitamini kushomeka kupererwa neropa, hutano hwekuwedzera hunogona semuenzaniso kukurudzirwa kurapa anisocytosis.