The term leukemoid tests designate the changes of reactive character in blood and bodies of a hemopoiesis developing at various diseases, reminding observed at leukoses and other tumors of the hemopoietic system, but which are not transformed to these tumors.
Epidemiology In literature the generalizing data analyzing prevalence of various forms of leukemoid tests on sufficient material in essence did not meet.
Etiology and pathogeny The leukemoid tests accompanying the course of many diseases are caused by an individual reactive condition of the hemopoietic bodies of the patient.
Classification Distinguish pseudo-blast, myeloid and lymphocytic leukemoid tests. Distinguish from reactions of myeloid type promiyelotsitarny, neutrophylic (with rejuvenation of a leykogramma to myelocytes and promyelocytes), eosinophilic. Refer the changes in a gemogramma at a number of diseases reminding a chronic lymphoid leukosis, and also the found morphological shifts at immunoblast lymphadenites to reactions of lymphoid type. The infectious mononucleosis, an infectious lymphocytosis, big eosinophilias of blood and monocytic and macrophagic leukemoid tests are separately given.
Approximate formulation of the diagnosis: 1. The pseudo-blast leukemoid test which developed at the beginning of stopping of an immune agranulocytosis. 2. The Promiyelotsitarny leukemoid test which developed after a pseudo-blast leukemoid test with emergence in blood of a large number of promyelocytes with plentiful granularity. 3. Neutrophylic, eosinophilic or lymphoid type the leukemoid tests with shift of a leykogramma to myelocytes arising against a number of diseases.
Clinic Pseudo-blast leukemoid tests are sometimes observed before an exit from the immune agranulocytosis provoked by pyramidon, Butadionum, streptocides, etc. They are characterized by existence in blood and marrow of a significant amount of cells with a homogeneous kernel, single nukleola, the blue narrow cytoplasm which is not containing granularity which mistakenly are accepted to blast. Unlike typical blasts in these cells there is no gentle network and uniformity of threads of chromatin. The temporary blastoza disappearing without it is applied iya cytostatic treatment and carried to L R, are observed at newborns with genetic defects of chromosomes more often at a Down syndrome.
Myeloid reactions. The Promiyelotsitarny leukemoid tests arising at an exit from an immune agranulocytosis after pseudo-blast reaction differ in emergence in blood of considerable number of promyelocytes with plentiful granularity that can be the cause of the wrong diagnosis of an acute promiyelotsitarny leukosis. Lack of a cellular atipizm, the polymorphic granularity giving positive reaction to the acid sulphated mucopolysaccharides, the expressed hemorrhagic syndrome, thrombocytopenia and anemia allow to reject this diagnosis.
Neutrophylic leukemoid tests with rejuvenation of composition of blood to myelocytes meet at the disseminated tuberculosis, dysentery, sepsis, scarlet fever, an ugly face, diphtheria, a lung fever, acute dystrophy of a liver, malignant tumors metastasises in marrow, collagenoses, medicinal intoxications and other processes. At a combination of massive blood losses to toxicoinfection the neutrophylic leukocytosis with sharply expressed band shift is observed. Neutrophylic leukemoid tests at cancer can be combined with a thrombocytosis, is more rare — a hyperglobulia (at a hypernephroma). Miliary metastasises of cancer in marrow are followed by receipt in blood of eritrokariotsit of various degree of a maturity along with mature neutrophils. More often anemia and thrombocytopenia come to light. The diagnosis is confirmed by detection of cancer cells in marrow bioptata, less often they come to light in marrow punctate.
Eosinophilic leukemoid tests can meet at a dochmiasis, an ascaridosis, an amebiasis, an opisthorchosis, some forms of a dermatosis (psoriasis, scaly deprive), tuberculosis, syphilis and other diseases, and also in the form of big eosinophilias of blood.
Leukemoid tests of lymphocytic type remind a blood picture at a chronic lymphoid leukosis. They are observed at an infectious lymphocytosis, an infectious mononucleosis, tuberculosis, malignant new growths, some viral infections, autoimmune diseases — chronic autoagressivny hepatitis, collagenoses. If the leukemoid test proceeds with a hyperadenosis, a liver, a spleen, it is necessary to carry out the differential diagnosis with malignant limfoproliferativny diseases (lymphoma, a chronic lymphoid leukosis, paraproteinemic hemoblastoses).
Carry also immunoblast lymphadenites reflecting immune process in lymph nodes to lymphocytic leukemoid tests. In response to stimulation V-lymphocytes undergo essential changes: the kernel of a cell and cytoplasm considerably increase, kernels konturirutsya well, the structure of nuclear chromatin becomes friable, gets a filamentous structure. Along with blasttransformirovanny lymphocytes (immunoblasts) plasmocytes and monocytes are found. Immunoblast lymphadenites are observed at an infectious mononucleosis, allergic dermatitis of a medicinal origin, adeno-and enteroviral infections, rhematoid polyarthritis, a system lupus erythematosus, an illness of cat's scratch, etc.
Verification of the diagnosis Establishment like leukemoid tests, developed against a certain basic disease, usually does not cause serious difficulties. Criteria of differentiation of promiyelotsitarny reactions and an acute promiyelotsitarny leukosis were already mentioned. Sometimes sharply developed consumption thrombocytopenia mistakenly is regarded as one of symptoms of an acute leukosis. The researches of a miyelogramma which are not revealing existence in it of a blastoz allow to refuse this diagnosis. In diagnosis of immunoblast limfoadenit, except the signs noted earlier, safety of a structure of a lymph node and a clear boundary of follicles matter.
Treatment Leukemoid tests, as a rule, do not demand special treatment as various changes inherent in them from a hemopoiesis disappear or abate after use of adequate therapy of a basic disease against which they arise. In this respect only separate options of the leukemoid tests proceeding despite treatment, without improvement of a clinical picture of a disease represent an exception, for example at miliary metastasises of cancer to marrow.