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Leukemoid tests of different types - 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
Immunotherapy
Remission and recurrence of an acute leukosis
Inborn leukosis
Neuroleukosis
Myelosis
Lymphogranulomatosis
Gematosarkoma
Macrofollicular lymphoma
Angioimmunoblastny lymphadenopathy
Leukemoid tests
Infectious lymphocytosis
Infectious mononucleosis
Leukemoid tests of different types
Dysfunctions of granulocytes
Leukopenias
Histiocytoses
Histiocytoses - an eosinophilic granuloma
Malignant histiocytosis
Family erythrophagocytal histiocytosis
Accumulation diseases
Nimann's illness — Peak
Angiopathies
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
Coagulopathies
Hereditary coagulopathies
Hemophilia And
Clinic of hemophilia
Treatment of hemophilia
Angiohemophilia
Cristmas disease (Kristmas's illness)
Hereditary deficit of factors of XI, XII, XIII and I
Dysfibrinogenemias
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
Thrombocytopenia
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
Trobotsitopatiya
Anemias
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

Leukemoid tests of monocytic type occur at children rather seldom and are still a little studied. Monocytic reaction is noted at hereditary forms of a neutropenia, infectious diseases with a long current — a septic endocarditis, rheumatism, a brucellosis, tuberculosis, slow sepsis, at acute protozoan diseases. As it was already specified, the quantity of monocytes considerably increases at an infectious mononucleosis.
Leukemoid tests of myeloid type meet at children's age less than lymphatic reactions. Distinguish pseudo-blast, promiyelotsitarny, neutrophylic with rejuvenation of structure of cells and eosinophilic forms.
According to I. A. Kassirsky (1970) and A. I. Vorobyov (1979), leukemoid tests with dominance of blast cells in peripheral blood and marrow is not present. Carry states at which single blast cells in peripheral blood are noted to pseudo-blast forms. However question of existence of this kind of leukemoid tests disputable. At children of chest age the hemopoietic device differs in lability that causes feature of reaction to various irritants. Newborns have a high leukocytosis and sharp rejuvenation of composition of peripheral blood with the advent of blast cells are observed at acute hemolitic process on the soil a Rhesus factor conflict. Similar reaction with the advent of blast cells in peripheral blood occurs at children of chest age at heavy bacterial infections — sepsis, toksikoseptichesky forms of pneumonia, especially staphylococcal etiology. In these situations there are certain difficulties in respect of differential diagnosis with an inborn leukosis. The complexity of a picture is connected with clinical similarity: high intoxication, as a rule, anemia, increase in a liver and spleen is possible. The careful kliniko-hematologic analysis, dynamic supervision, if necessary — research of a miyelogramma have diagnostic value. Absence of a blast metaplasia of marrow, safety of erythroidal and platelet sprouts of a hemopoiesis allow to exclude an acute leukosis.
At children of different age leukemoid tests of promiyelotsitarny and neutrophylic type are observed. Development of such states is provoked by different factors. At the same time are noted a leukocytosis within 15 X 109/l — 40 X 109/l, a relative and absolute neutrocytosis with a deviation to the left to metamyelocytes. As a rule, strong irritants cause higher leukocytosis and more expressed shift. This feature clearly is traced at the children of chest age giving leukemoid tests more often than more senior children.
In emergence of leukemoid tests of myeloid type the large role is played by infectious and inflammatory diseases: sepsis, pneumonia, purulent processes, scarlet fever. At children the clinical signs of a basic disease which are followed by intoxication, high temperature, increase in SOE, etc. are noted. Reaction usually has the maximum expressiveness at disease height, in process of subsiding of pathological process also hematologic changes decrease.
In an etiology of leukemoid tests at children intoxication ekzo-and endogenous character takes place. The high leukocytosis with shift is observed to the left at long reception of high doses of sulfanamide drugs. It is especially actual in pediatric practice as the last widely appoint to children without the bases, weighty on that. Leukemoid states are observed at reception of adrenaline, a digitalis, a poisoning with carbon monoxide. Reactions of myeloid type can develop at the endogenous intoxications caused by azotemic uraemia, metabolic disturbances, acidosis.
At children's age such factors as the ionizing radiation, the malignant new growths leading to development of leukemoid tests of myeloid type have smaller value.
The expressed myeloid reaction with existence of myelocytes, less often than imperious cells is observed at children at an exit from an acute stage of an agranulocytosis. The leukocytosis can reach high figures — 30 X 109/l — 50 X 109/l. Less expressed reaction is observed at acute blood loss, characterized by a moderate leukocytosis and shift of a formula to metamyelocytes and myelocytes to the left.
In differential diagnosis of leukemoid conditions of myeloid type with an acute and chronic leukosis basic signs are clinical symptoms of a basic disease against which reaction develops. The analysis of hematologic changes in dynamics, in process of subsiding of the main process is of great importance; the composition of peripheral blood is normalized without specific treatment. In the presence of a large number of promyelocytes of big difficulties in differential diagnosis with an acute promiyelotsitarny leukosis does not arise. The dominating clinical symptoms of the last are the expressed hemorrhagic syndrome and thrombocytopenia.
The blood picture at leukemoid tests of myeloid type has a certain similarity to a myelosis — a leukocytosis, a neutrocytosis with shift to the left. At children with heavy septic process increase in a spleen can be also noted that supplements similarity to a myelosis. However at leukemoid states less expressed "left" shift in a leykogramma is noted. Morphologically in neutrocytes reveal toxic granularity that is a characteristic sign of inflammatory process. In peripheral blood at leukemoid states there is no eosinophilic and basphilic association. At septic processes the spleen increases moderately, at a palpation it a soft consistence. The myelosis is characterized expressed splenomegaliyoy, a spleen dense. The sternal puncture has no important differential diagnostic value. The main issues are resolved on the basis of clinical data, by pictures of peripheral blood and supervision over patients in dynamics. A valuable diagnostic character — activity of an alkaline phosphatase of neutrocytes: at a myelosis it clearly is lowered, leukemoid tests are characterized by a superactivity of enzyme.
In pediatric practice meets many diseases which are followed by a moderate eosinophilia. Slight increase of maintenance of eosinophilic granulocytes in peripheral blood is observed also at almost healthy children. These states do not draw attention and do not cause special fear. Along with it it is possible to find the eosinophilia of high degree which is combined with a leukocytosis. Such states at which against a leukocytosis the quantity of eosinophilic granulocytes exceeds 15 — 20% are allocated in separate group — big eosinophilias of blood. This group is extremely various on the etiological factors therefore such allocation is conditional. However the hematologic syndrome — a big eosinophilia of blood — quite often is leading and only in a picture of a disease and serves as a starting point in diagnosis. Despite a variety of etiological agents in development of eosinophilic reactions, at any diseases there is a number of the general pathogenetic mechanisms. Now existence of the chemotactic factors operating in the basic on eosinophilic granulocytes and leading to increase of their products is proved. Such factor appears during an inflammation against reaction IgG antigen antibody. The factor resulting from release of mediators at immunological reactions antigen — IgE antibody has specific effect. The chemotactic factor is capable to activate various connections — polysaccharides, fabric proteins. At autoimmune processes antigenstimulirovanny lymphocytes have specific effect on eosinophilic granulocytes that can explain developing of a big eosinophilia of blood at collagenoses. Now it is proved that at a fabric invasion helminths produce the substances activating a chemotactic factor.
The leading role in development of eosinophilic reactions is played by parasitic diseases. In turn the high eosinophilia is more characteristic of fabric forms of helminths that is when the parasite passes the most part of the development directly in body tissues (a trichinosis, a fascioliasis, a strongyloidosis, opistrokhoz). The leukemoid test of eosinophilic type occurs at children at a migratory stage of an ascaridosis. Changes in blood are observed in early terms after infection. Usually they are most expressed at the beginning of an invasion and at death of parasites. Quite often hematologic syndrome is the only symptom of a disease that demands careful clinical laboratory research for identification of a helminthic invasion. In peripheral blood the leukocytosis is usually moderately raised — 10ò109/l — 20Õ109/l, in rare instances it reaches 30ò109/l and more. Intestinal forms of a parasitic infection usually are not followed by a big eosinophilia of blood. However at children at certain features of reactivity of an organism development of a leukemoid test of eosinophilic type at an intestinal form of an ascaridosis, a lambliasis is possible and even at an enterobiosis, and also the mixed infection. The hypereosinophilia can be observed at migration in a human body of larvae of dog and cat's ascarids. At identification at children of a high eosinophilia of not clear etiology careful searches of helminths always have to be undertaken. L. D. Grinshpun (1962) notes great diagnostic value of the scheme of N. N. Plotnikov allowing to find or exclude practically in all cases a helminthic invasion. The main stages of diagnosis according to this scheme the following: 1. Repeated researches of peripheral blood. 2. Careful clinical inspection of the patient. 3. Repeated, repeated researches calla. 4. Repeated, repeated duodenal sounding (for 4 months and more from the moment of emergence of an eosinophilia). 5. Serological tests (at suspicion on a trichinosis or migration of larvae of ascarids or a filariasis). 6. X-ray inspection. 7. Histologic studying of a bioptat of muscles, lymph nodes. 8. In especially difficult cases — treatment of ex juvantibus according to the suspected helminthosis form.
Diagnosis is promoted also by a number of the clinical signs observed at helminthic invasions. The children having an opisthorchosis and a fascioliasis complain of a pristupoobrazny abdominal pain. Fever, a hyperadenosis, a liver and a spleen, a mialgiya and an arthralgia are observed. At a strongyloidosis the abdominal pain, a diarrhea, moderate increase in a liver, skin manifestations in the form of the small tortoiseshell are noted.
The clinical picture at an ascaridosis is characteristic. Children have a bloated pale face, the liver, a spleen are increased, the sialosis is raised. They complain of an abdominal pain, nausea, in a dream grit the teeth.
At an enterobiosis the itch in the field of an anus disturbs. The sleep and an emotional condition of the child is interrupted.
Leukemoid tests of eosinophilic type are observed at various forms of kollagenoz. Most often the eosinophilia is noted at a nodular periarteritis. At its asthmatic form cases with a leukocytosis more than 30 X 109 and quantity of eosinophils to 80% are described. The moderate eosinophilia of blood is noted at a system scleroderma. The system lupus erythematosus, as a rule, proceeds with an eosinophilia. In recent years in a separate form the allergic vasculitis which is followed by a big persistent eosinophilia of blood is allocated. In the first descriptions of this pathology at children the eosinophilia was regarded as a pathognomonic symptom of a disease. The eosinophilia pathogenetic is caused by the general allergic component therefore it can be observed at a number of allergoses — respiratory pathology, skin diseases, defeats of digestive and cardiovascular systems. The big eosinophilia of blood is noted at the peculiar pulmonary pathology known under the name of eosinophilic infiltrates, or Leffler's syndrome. Now at damage of lungs allocate several forms. General signs of eosinophilic infiltrates of lungs following: the acute beginning of a disease, temperature, short wind, cough with expectoration, thorax pain. These symptoms vary from the minimum manifestations to expressed. Radiological in lungs define low-intensive shadows of irregular shape with indistinct contours. The volatility is characteristic of eosinophilic infiltrates of lungs. In peripheral blood — a moderate leukocytosis and an eosinophilia of 20 — 40%. The disease usually lasts 7 — 10 days, however can drag on also for several months. At one time eosinophilic infiltrates considered as manifestation of a helminthic invasion. Now it is proved that the disease is polietiologichny.
The hypereosinophilia is noted at prolonged use of medicinal substances. In parallel with it development of heavy allergic and toxic reactions is possible. At the same time the eosinophilia can be the only manifestation of a drug disease. Sulfanamide drugs and antibiotics are most dangerous in this respect. Usually leukemoid test can develop at prolonged use of drugs (2 — 3 weeks). The moderate leukocytosis and an eosinophilia within 10 — 20% are noted. Cases with a high leukocytosis and a large number of eosinophils — 30 — 50% are described. In certain cases eosinophilic reaction is observed after radiation.
The big eosinophilia of blood of not clear genesis always has to cause oncological vigilance. Such reaction is optional, but, perhaps, the first clinical display of malignant diseases — a myelosis, a lymphogranulomatosis, an acute leukosis. The hypereosinophilia can be observed also in the developed stage of malignant new growths.
Valleder's syndrome (S. of Walleder, 1945) is characterized by a leukemoid test of eosinophilic type. The disease carries still the names "infectious eozinofilez", "eosinophilic illness". The etiology is not clear. Etiological agents, famous in development of eosinophilic reactions, allow to exclude careful research and long supervision over patients and to allocate a separate form of an illness. Clinical signs following: fever, lymphadenopathy, gepatosplenomegaliya, mialgiya, arthralgias, catarral phenomena. The acute picture of a disease is kept by 2 — 3 weeks. Further the wavy current with the aggravation periods can be observed. In peripheral blood — a high leukocytosis — 30 X 109/l — 70 X 109/l, a considerable eosinophilia — 40 — 80%, sometimes and more. Find mature forms of eosinophilic granulocytes in peripheral blood, punctates of marrow and lymph nodes. According to L. D. Grinshpun (1962), confirmation of the diagnosis of an infectious eozinofilez is possible only at a reliable exception of all probable causes, especially helminthic invasion and long supervision over patients not less than a year. The disease proceeds is benign. The quantity of leukocytes and eosinophilic granulocytes after an acute phase of an illness gradually decreases. However trace reaction still remains long time. At a palindromia return of hematologic symptomatology is also noted. The forecast at an infectious eozinofilez favorable.
Rare pathology is the hereditary family and constitutional eosinophilia. It proceeds is good-quality and accidentally it is found in almost healthy people. Careful inspection and long supervision do not reveal any pathology. In peripheral blood — a moderate leukocytosis (10 X 109/l — 15ò109/l) and an eosinophilia within 15 — 40%. Similar changes can be registered at several family members. Overall health and working capacity at such people do not suffer.
The Polietiologichnost of big eosinophilias of blood demands to carry out in each specific situation the careful and sequential clinical laboratory analysis for identification of a basic disease. It in turn defines rational therapy. There is no special treatment of patients with an eosinophilia of blood. Therapy of a basic disease is carried out. Now there is a large amount of the drugs allowing to carry out effectively fight against helminths. Sick with allergoses appoint the desensibilizing drugs and according to indications — glucocorticoid hormones. In case of development of a drug disease drugs cancel. Uncomplicated cases do not demand any treatment. At emergence of other symptoms of an allergy appoint the desensibilizing therapy. If the current of allergoses becomes complicated, then the short rate of steroid hormones, symptomatic therapy is recommended. Carry out by the patient with an infectious eosinophilia the desensibilizing therapy, at a heavy current — corticosteroid hormones. During the acute period appoint pyrazolon derivatives.



 
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