内科学第六篇 第章 白血病.ppt

Immnuophenotyping panel used in St. Jude Children’s research hospital U.S.A. CD13 CD33 CD19 CytoCD79a CD7 CytoCD3 AML - - - - B-ALL - - - - T-ALL - - - - By using this method of analysis, one can make a firm diagnosis in 99% of cases 免疫表型分型方案 T 细胞 B 细胞（4%） B 细胞前体 CD7（敏感），cCD3 （特异） CD19 (敏感), cCD79a (特异) 成熟T 细胞 （18%） 前 T 细胞（6%） 前 B-细胞 （9%） 早期前-B 细胞 （52%） 前-前- B 细胞 （11%） sIg?, sIg? Insert table 90% of the cases with leukemia have non-randomized translocation P118 types of translocations CML AML-M2 AML-M3 AML-M4 AML AML-M4E0 Other new developed methods Differential Diagnosis Pseudoleukemia Myelodysplastic syndrome Nonleukemic pancytopenia Treatment Supportive cares and preparation of the patients Antileukemic therapy Therapy of the central nervous system Stem cell transplantation Anemia Hemorrhage Infection Hematological support Transfusion of Platelets Transfusion of packed red cells Transfusions of granulocytes Transfusions of IgG Infection control Special precautions: protective isolation Elimination of contaminated foods Oral and digestive system care Broad spectrum antibiotics GM-CSF administration Antileukemic therapy Chemotherapy to kill leukemia cells using strong anti-cancer drugs Treatment phases Induction therapy: the aim is to bring about remission , that is leukemic cells are no longer found in the bone marrow and the recovery of normal hematopoiesis Post-remission therapy: to eliminate any leukemia cells potential hiding in the body Special subtypes Acute promyelocytic Leukemia (APL): because of the small particles (procoagulants) inside the APL cell, D