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患者女,57岁,因头晕、乏力3个月而就诊。查体:T36.4℃,肝剑下2cm,肋下未及,脾肋下6cm,胸骨压痛。血像:Hb140g/L,RBC5.0×10~(12)/L,WBC35.2×10~9/L,中性92％。无幼稚细胞,PIt420×10~9/L,部分粒细胞浆中颗粒粗大及分叶过多。用大量抗生素治疗无效,WBC持续高于35×10~9/L,以成熟中性粒细胞为主。骨髓像示有核细胞明显增生,嗜酸性粒细胞0.5％,红系、淋巴系比值减低。全片巨核细胞321个,以颗粒巨、产板巨为主,血小板呈片多见,中性粒细胞碱性磷酸酶(NA°P)阳性率94％,积分370,尿酸470μmol/L。脾穿刺涂片见大量成熟中性粒细胞及少数中晚幼粒细胞,临床诊断为慢性中性粒细胞白血病。
The patient, 57 years old, presented with dizziness and fatigue for 3 months. Physical examination: T36.4°C, 2cm under the liver blade, less than the ribs, 6cm subpleural and sternal tenderness. Blood image: Hb140g/L, RBC5.0×10~12/L, WBC35.2×10~9/L, neutral 92%. No immature cells, PIt420 × 10 ~ 9 / L, part of the granulocyte slurry coarse and too much leaves. With a large number of antibiotics ineffective, WBC continued to be higher than 35 × 10 ~ 9 / L, mainly in mature neutrophils. Bone marrow imaging showed a marked proliferation of nucleated cells, 0.5% of eosinophils, and reduced erythroid and lymphoid ratios. There were 321 megakaryocytes in the whole body, with giant granules and plate giants predominating. Platelets were most common. The positive rate of neutrophil alkaline phosphatase (NA°P) was 94%, integral 370, and uric acid 470 μmol/L. Spleen puncture smear see a large number of mature neutrophils and a small number of medium and late myeloid cells, clinical diagnosis of chronic neutrophil leukemia.