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Leukemoid tests - Practical hematology of children's age

Table of contents
Practical hematology of children's age
Embryonal hemopoiesis
Morfofunktsionalny characteristic of cells of marrow and peripheral blood
Marrow parenchyma cells
Peripheral blood of children of different age
The system of a hemostasis is normal
Etiology and pathogeny of leukoses
Acute leukoses
Acute leukoses - a preleukosis
Possibilities of a predictive assessment of a course of an acute lymphoblastoid leukosis at children
General principles of treatment of an acute leukosis
Chemotherapeutic drugs
Treatment of an acute lymphoblastoid leukosis
Treatment of myeloid forms of an acute leukosis
Infectious complications and symptomatic therapy of an acute leukosis
Consolidation and maintenance therapy of an acute leukosis
Remission and recurrence of an acute leukosis
Inborn leukosis
Macrofollicular lymphoma
Angioimmunoblastny lymphadenopathy
Leukemoid tests
Infectious lymphocytosis
Infectious mononucleosis
Leukemoid tests of different types
Dysfunctions of granulocytes
Histiocytoses - an eosinophilic granuloma
Malignant histiocytosis
Family erythrophagocytal histiocytosis
Accumulation diseases
Nimann's illness — Peak
Hemorrhagic vasculitis (Shenleyn's illness — Genokh)
Mayokki's purpura
Ataxy teleangiectasia
Entsefalotrigeminalny angiomatosis
Kortiko-meningealny diffusion angiomatosis
Cerebroretinal angiomatosis
Hypertrophic gemangiektaziya
Multiple and huge hemangiomas
Elastic fibrodisplaziya
Hereditary coagulopathies
Hemophilia And
Clinic of hemophilia
Treatment of hemophilia
Cristmas disease (Kristmas's illness)
Hereditary deficit of factors of XI, XII, XIII and I
Hereditary deficit of factors of VII, X, V and II
Deficit K-vitaminozavisimykh of factors of coagulation
Syndrome of the disseminated intravascular coagulation
Clinic and diagnosis of the IDCS
Treatment of the IDCS
Idiopathic Werlhof's disease
Clinic and diagnosis of an idiopathic Werlhof's disease
Treatment of an idiopathic Werlhof's disease
Isoimmune Werlhof's disease
Transimmune Werlhof's disease of newborns
Trombogemolitichesky Werlhof's disease (syndrome Moshkovich)
Hereditary Werlhof's diseases
The anemias connected with blood loss
Chronic posthemorrhagic anemia
Iron deficiency anemias
Clinic and diagnosis of an iron deficiency anemia
Treatment of iron deficiency anemias
Sideroakhrestichesky, sideroblastny anemias
Megaloblastny anemias
Foliyevodefitsitny anemia
Hereditary forms of megaloblastny anemias
Hereditary dizeritropoetichesky anemias
The anemias connected with oppression of proliferation of cells of marrow
Hereditary hypoplastic anemias
Hemolitic anemias
Hemolitic anemias - an ovalocytosis, a hereditary stomatocytosis
Acanthocytosis, piknotsitoz
The hereditary hemolitic anemias connected with disturbance of activity of enzymes of erythrocytes
The hereditary hemolitic anemias connected with disturbance of structure or synthesis of hemoglobin
The acquired immune hemolitic anemias
Isoimmune hemolitic anemias
Treatment of a hemolitic illness of newborns
Autoimmune hemolitic anemias
List of references

Chapter IV
Leukemoid tests are the reactive disturbances in the hemopoietic system which are characterized by permanent increase in quantity of leukocytes and change of qualitative composition of white blood. As I. A. Kassirsky specifies, at leukemoid tests the picture of blood is similar to that at leukoses, however these states are various on a pathogeny. The leukosis is primary tumoral disease of the hemopoietic device. Leukemoid tests represent secondary, symptomatic, to a certain extent functional, changes of the hemopoietic system. At leukemoid tests there is a cellular substrate, similar to a leukosis, however it is never transformed to a tumor to which it is similar (A. I. Vorobyov, 1979). Even the considerable leukocytosis which is found at leukemoid tests is never followed by a hyperplasia of bodies. These states represent a peculiar hyperreactive reaction of the hemopoietic device to various irritants. The etiological factors causing development of leukemoid tests are various. These are bacterial and viral infections, helminths, protozoa, states after acute and chronic intoxication, impact on an organism of toxic substances, etc. The same etiological factors can cause leukemoid tests of various types. At the same time it is possible to note a certain tipospetsifichnost. So, helminthic invasions generally lead to development of leukemoid tests of eosinophilic type, viral infections — lymphatic type. In each case it is necessary to analyze and find out carefully an etiological factor as treatment of a basic disease is the cornerstone of therapy of leukemoid tests. Questions of a pathogeny of leukemoid states are completely not studied so far. The same irritant operating on an organism in one cases provokes development of leukemoid tests, and in others — remains intact. It in many respects is defined by individual reactivity of an organism. Possibly, leukemoid tests are inherent to children with giperergichesky type. In a gistopatogeneza of leukemoid tests the insignificant reactive hyperplasia of a white sprout of a hemopoiesis takes place. The leukemoid test represents not a certain nosological form, but a hematologic syndrome of any disease. Therefore along with a specific picture of blood find also clinical symptoms of the main pathology. Leukemoid tests often arise at children's age. It is connected with anatomo-physiological features of an organism of the child, lability of the hemopoietic device. Told especially treats newborns and children of chest age. At this age leukemoid tests easily arise on any irritants, even at physical effort, pain, fear, cough, deep breath. A certain pattern is traced: stronger irritants cause a bigger leukocytosis and change of a leykogramma. At a blood picture assessment at children of younger age it is necessary to remember physiological features — about dominance of lymphocytes over neutrocytes.
During leukemoid tests conditionally allocate three periods (I. A. Kassirsky, 1970): 1) the expressed leukemoid test; 2) recession of a leukemoid test; 3) normalization with trace .reaktion.
Considering a variety of etiological factors in development of leukemoid tests and the fact that they are a secondary syndrome of a disease, there is no uniform classification now. In domestic hematology division of leukemoid tests on the basis of hematologic signs is standard. Allocate two main groups: 1. Leukemoid tests of myeloid type. 2. Leukemoid tests of lymphatic and monocytic and lymphatic type. At statement of the diagnosis, except establishment like a leukemoid test, it is necessary to specify an etiological factor.
At children's age leukemoid tests of lymphatic type most often meet. They develop against a respiratory viral infection, at many children's infectious diseases (a rubella, scarlet fever, whooping cough, chicken pox), tuberculosis. At some diseases lymphatic reaction is a pathognomonic symptom of a disease (an infectious mononucleosis and an oligosymptomatic infectious lymphocytosis).
The symptomatic lymphocytosis can be observed at children at acute respiratory and viral infections. It is big etiological group into which the following nosological forms enter: flu, parainfluenza, adenoviral, enteroviral, rinovirusny, reovirusny, syncytial and viral infections. The relative lymphocytosis against a leukopenia is usually observed against these diseases on 2 — the 5th day.
However at some children, especially at the complicated course of a disease (lymphadenitis, otitis, pneumonia), leukemoid tests of lymphatic type are observed. Specific characters, except signs of a basic disease, no. In blood define the leukocytosis over 10 X 109/l in rare instances reaching big figures — 50 X 109/l. In a leykogramma the quantity of lymphocytes reaching peak (50 — 80%) on the 2nd week of a disease is increased. At the complicated course of a viral infection there can be an unsharp neutrophylic shift to the left. In neutrocytes toxic granularity can be defined. In a miyelogramma there are also no specific changes. Marrow corresponds to a picture of peripheral blood with some increase in cellular structure of maintenance of lymphocytes. Except lymphocytes of usual morphology with a compact kernel and a narrow rim of cytoplasm, in peripheral blood and marrow the activated forms of lymphocytes meet. The cell increases in sizes, the gentle and mesh structure of a kernel, large homogeneous kernels, wide cytoplasm are defined. In the presence of clinical manifestations of a basic disease differential diagnosis does not represent difficulties. The leukemoid test has no crucial importance during a disease therefore special treatment is not required. In process of reduction of the main process the leukocytosis and quantity of lymphocytes decrease. As a rule, the leukemoid test at respiratory and viral pathology sticks to 2 — 4 weeks.
Long leukemoid tests of lymphatic type are often observed at children at whooping cough. The insignificant leukocytosis within 15 — 20 X 109/l can be noted already during the catarral period of a disease which duration makes to 2 weeks. Gradually the leukocytosis and a lymphocytosis accrue, reaching a maximum during the spasmodic period. The quantity of leukocytes can increase to 70 — 80 X 109/l and more. Usually it fluctuates within 20 — 40 X 109/l. Changes in a leykogramma are characterized by increase in quantity of lymphocytes. The lymphocytosis reaches 70 — 80%. Degree and duration of a leukemoid test in a certain measure display a current of a basic disease. The heavier whooping cough proceeds, the higher and is longer the leukocytosis and a lymphocytosis remain. Except usual lymphocytes, in a leykogramma atypical forms, prolymphocytes, lymphocytes meet azurophilic granularity. There are no specific changes in a miyelogramma. The typical clinical picture of whooping cough allows to regard hematologic changes correctly. The leukemoid test is expressed throughout the spasmodic period of a disease and disappears together with elimination of pertussoid infectious process. Thus, the hematologic syndrome is kept by 5 — 10 weeks. At the children imparted against whooping cough, the disease proceeds easier and the leukemoid test is weaker.
Leukemoid tests can be observed at the children having scarlet fever. And in development of a hematologic syndrome there are periods, certain, characteristic of this disease. The leukocytosis is noted from the first days of a disease, making 10 — 30 X 109/l, in rare instances the quantity of leukocytes exceeds this level. The leukemoid test remains 2 — 4 weeks. In the first week of a disease in a leykogramma the quantity of neutrocytes is increased, in hard cases their number reaches 50 — 80%. From the moment of emergence of rash — 3 — the 4th put diseases — the quantity of eosinophilic granulocytes increases, reaching 15 — 20%. On the 2nd week of a disease the neutrocytosis and an eosinophilia decrease and in peripheral blood lymphatic cells prevail, the leukocytic formula is gradually normalized.
At some children during the second allergic period of a disease the moderate eosinophilia can be noted again.
The symptomatic lymphocytosis is observed at the children having a rubella. Serve as typical symptoms of a rubella increase zadnesheyny, occipital, existence of skin rash is more rare than other groups of lymph nodes, and also. Hematologic changes appear in a stage of rash and are characterized by a lymphocytosis and a significant amount of plasmocytes. Changes in a leykogramma usually proceed against a leukopenia that is more characteristic of a rubella. However in some cases the leukocytosis, sometimes considerable can be noted (40 X 109/l) that defines diagnosis of a leukemoid test of lymphatic type. Existence of typical clinical signs of a rubella considerably facilitates differential diagnosis. The return dynamics of a hematologic syndrome corresponds to the main process, and the composition of peripheral blood is normalized in 1 — 2 week after the beginning of a disease.
Leukemoid tests of lymphatic type can be observed at the children having chicken pox. The blood picture at this disease is variable. At most of patients the quantity of leukocytes remains normal, in some cases the leukopenia is noted, and at some children the leukocytosis sometimes reaching considerable level (30 — 40ò109/l) can be observed. More characteristic hematologic syndrome, irrespective of quantity of leukocytes, is change of a leykogramma. At chicken pox the neutropenia and a lymphocytosis are observed. At a leukopenia the lymphocytosis has relative character. If zhb the quantity of leukocytes is increased, then the hematologic syndrome on character reminds a leukemoid test of lymphatic type. Hematologic changes are most expressed during rash. The composition of peripheral blood is normalized later 2 — 3 weeks from the beginning of a disease.
Leukemoid tests of lymphatic type can be observed at tubercular intoxication, tonzillogenny intoxication. At some children they appear during the postvaccinal period. The forecast at leukemoid tests of lymphatic type depends on character of a basic disease against which they develop; in most cases it is favorable. In general leukemoid tests are reflection of a basic disease. At its treatment also the leukemoid test disappears though it can have longer trace current. As a rule, the quantity of leukocytes, and in later terms — a leukocytic formula is originally normalized. Leukemoid tests of lymphatic type do not demand special therapy, treatment of a basic disease is carried out.

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