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本文报道1例可能为药物所致纯红细胞再障(PR-CA)病人,其后演变为慢性粒细胞白血病(CML)并最终死于急淋变。提出细胞遗传学分析与祖细胞测定对确定白血病前期性PRCA有重要意义。29岁男性病人,患癫痫应用补痫酮治疗数年,并有免疫性疾病有关症状,血像和骨髓像检查符合PRCA诊断。考虑有药物诱发的可能而中断扑痫酮治疗,应用强的松龙和环磷酰胺。病人对治疗反应良好,其后1.5年不需输血。初诊8个月后,血像具有CML慢性期特点,再度出现关节痛和血管炎而加大免疫抑制剂量。两年后,出现CALLA~+急淋危象,7个月后死亡。诊为PRCA时,骨髓培养G分带技术表现为含46—48
This article reports a case of drug-induced pure red cell aplasia (PR-CA) patients, then evolved into chronic myeloid leukemia (CML) and eventually died of acute lymphoid changes. Proposed cytogenetic analysis and progenitor cell determination of leukemia to determine the significance of PRCA. 29-year-old male patient suffering from epilepsy seizure treatment for several years, and immune-related symptoms, blood and bone marrow examination consistent with PRCA diagnosis. Consider the possibility of drug-induced interruption of epidroxenone treatment, the application of prednisolone and cyclophosphamide. The patient responded well to treatment, with no subsequent blood transfusion in the next 1.5 years. 8 months after the first visit, the blood has the characteristics of CML chronic phase, joint pain and vasculitis again and increase the immunosuppressive dose. Two years later, CALLA ~ + acute crisis appeared, died after 7 months. When diagnosed as PRCA, bone marrow culture G-banding technique appears to contain 46-48