白细胞减少症的中西医诊治

白细胞减少症是指外周血白细胞计数低于4．0×10^9／L。白细胞减少者大多数是中性粒细胞减少,外周血中粒细胞绝对数低于2．0×10^9／L,称中性粒细胞减少。如粒细胞低于0．5×10^9／L,称粒细胞缺乏症。     

粒生素在治疗化疗导致白细胞减少中的临床应用

为观察粒生素 (rhG CSF)在治疗恶性肿瘤化疗所致白细胞减少的疗效及临床不良反应 ,对 32 7例次恶性肿瘤化疗所致白细胞减少的患者使用粒生素 2 .5 - 5 μg (kg·d) ,皮下注射。结果表明 :Ⅰ和Ⅱ度骨髓抑制白细胞恢复正常所用粒生素的平均剂量为 2 37μg ,Ⅲ和Ⅳ度为 6 75 μg。治疗总有效率为 99.4 %。临床应用中未发现明显副反应。结论 :粒生素在治疗恶性肿瘤化疗所致的白细胞减少中具有良好的临床有效性和安全性。     

重组粒细胞集落刺激因子对血液恶性肿瘤病人外周血白细胞的影响

目的：探讨血液系统恶性肿瘤病人化疗后应用rhG—CSF外周血白细胞的形态变化。方法：采用血液分析仪进行外周血白细胞计数，新鲜血涂片瑞氏染色后油镜下观察白细胞形态，同时进行中性粒细胞碱性磷酸酶染色(NAP)。结果：①应用rhG—CSF前，部分中性粒细胞胞浆内中性颗粒数减少；应用rhG--CSF后，中性粒细胞胞浆内“中毒”颗粒数、空泡数和Dohle小体数增加；用rhG—CSF前、后比较，各组中性粒细胞胞体大小和核分叶无明显变化，嗜酸、嗜碱细胞、单核细胞及淋巴细胞形态也无明显改变。②用rhG—CSF后，各组NAP积分显高于用药前。结论：G-CSF可引起外周血中性粒细胞形态出现变化，内、外源性G—CSF均能改变中性粒细胞形态，且变化相似。     

初发急性白血病初期化疗的疗效预测

急性白血病要获完全缓解 (CR)必须经过化疗后的骨髓增生抑制期。在此期间外周血白细计数必然急剧减少。为了观察急性白血病化疗后白细胞 (WBC)计数与化疗疗效之间的关系 ,对 80例初治急性白血病患者在诱导化疗第 1疗程后WBC计数与疗效关系进行了分析。根据化疗后白细胞数的最低值分为 3组 :≤ 0 .4× 10 9/L组 ;(0 .4 - 0 .9)× 10 9/L组 ;>0 .9× 10 9/L组。结果表明 :初治急性白血病化疗第 1疗程后 ,WBC计数≤ 0 .4× 10 9/L的急性白血病CR率 6 0 % ,总有效率 90 % ;WBC计数在 (0 .4 - 0 .9)× 10 9/L的急性白血病CR率 5 5 .6 % ,总有效率 92 .6 % ;WBC计数 >0 .9× 10 9/L的急性白血病CR率 2 7.3% ,总有效率 6 6 .7%。白细胞≤ 0 .4× 10 9/L组 ,(0 .4 - 0 .9)× 10 9/L组与 >0 .9× 10 9/L组第 1疗程化疗有效率有显著性差异 (P <0 .0 1)。而白细胞≤ 0 .4× 10 9/L组与白细胞 (0 .4 - 0 .9)× 10 9/L组无明显差异。结论 :初发急性白血病第 1疗程化疗后白细胞计数可作为急性白血病化疗的一个预测指标。     

国产rhG-CSF治疗肿瘤化疗所致白细胞减少的临床分析

骨髓抑制引起白细胞减少是许多化疗药物的剂量限制性毒性之一。为评价国产rhG CSF(粒生素 )对肿瘤患者化疗所致白细胞减少症的疗效 ,对 132例恶性肿瘤患者 ,其中包括肺癌 80例 ,乳腺癌 35例 ,鼻咽癌 10例 ,恶性淋巴瘤 3例 (NHL ) ,胃癌 2例 ,原因不明骨转移癌 2例 ,在 5 2 8周期的化疗中 ,针对不同程度白细胞减少 ,采用不同剂量粒生素治疗 ,于化疗结束后 2 4小时至 15天内复查血常规。结果表明 ,Ⅰ -Ⅱ度白细胞减少患者皮下注射粒生素 75 μg/d× 3天 ,Ⅲ度 15 0 μg/d× 4天 ,Ⅳ度 30 0 μg/d× 5天 ,使Ⅰ -Ⅱ、Ⅲ和Ⅳ度患者白细胞恢复到正常时间分别为 2 5 ,4 2和 7天 ,缩短了白细胞缺乏症的持续时间。结论 :促进白细胞的恢复不仅可使肿瘤患者不发生因白细胞减少所致的发热、感染等并发症 ,还可使患者能够获得足够剂量强度的抗肿瘤药物 ,按期完成计划剂量强度治疗 ;粒生素无明显副作用 ,且疗效较好     

扶正升白汤治疗恶性肿瘤化疗后白细胞减少68例临床观察

目的研究扶正升白汤在恶性肿瘤患者化疗后白细胞减少临床治疗中的效果。方法选取某院于2016年1月至2017年6月收治136例恶性肿瘤化疗后白细胞减少患者,随机分成两组,对照组给予重组人粒细胞刺激因子,观察组患者给予扶正升白汤加减治疗。对比两组患者的临床疗效,治疗前后中性粒细胞绝对值,白细胞计数以及不良反应。结果治疗3周后,观察组总有效率91.18%,临床疗效显著优于对照组的77.94%(P0.05)。治疗前,两组患者白细胞计数和中性粒细胞绝对值差异无统计学意义(P0.05);经治疗3周后,对照组白细胞计数和中性粒细胞绝对值分别为(3.66±0.28)×10~9/L,(2.61±0.55)×10~9/L,观察组分别为(4.57±0.39)×10~9/L,(4.26±0.43)×10~9/L,两组均呈上升趋势,且观察组显著高于对照组(P0.05)。两组患者均未发生严重不良反应。结论扶正升白汤能够有效抑制恶性肿瘤患者化疗后白细胞减少,增加白细胞和中性粒细胞的数量,药物安全可靠,有效改善患者的病情,提高患者的生活质量。     

粒细胞集落刺激因子联合化疗对儿童急性淋巴细胞白血病临床探讨

目的探讨基因重组人粒细胞集落刺激因子（rhG—CSF）联合化疗治疗小儿急性淋巴细胞白血病（ALL）临床疗效。方法选择我院2006年4月至2008年4月初治ALL诱导化疗后中性粒细胞减少患儿50例,分为治疗组和对照组。对照组给予VDP（长春新碱、柔红霉素、泼尼松）或CODP＋I（环磷酰胺、长春新碱、柔红霉素、泼尼松、天门冬酰胺酶）方案;治疗组在对照组基础上,治疗组加用rhG—CSF。观察两组诱导完全缓解率、外周血中性粒细胞绝对值（ANC）恢复至1．0×10’／L的时间、发热持续时间和抗生素应用时间。结果两组完全缓解率没有显著差异（P〉0．05）,但两组外周血ANC恢复至1．0×10^9／L的时间、发热持续时间、抗生素应用时间有显著差异（P〈0．05）。结论rhG—CSF可治疗化疗所致的骨髓抑制,降低感染发生率及严重程度,是安全、有效的。     

聚乙二醇化重组人粒细胞刺激因子预防急性淋巴细胞白血病患儿化疗后中性粒细胞减少的临床疗效观察

目的 探讨聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)预防急性淋巴细胞白血病(ALL)患儿化疗后中性粒细胞减少的临床疗效。方法 回顾性分析2020年7月至2023年7月在绵阳市中心医院就诊的60例急性ALL患儿的临床资料。根据治疗方法不同将患儿分为观察组和对照组,各30例。对照组采用重组人粒细胞刺激因子(rhG-CSF)进行干预,观察组采用PEG-rhG-CSF进行干预。比较两组患儿化疗前及化疗3周后绝对中性粒细胞计数(ANC)和白细胞计数(WBC)水平,化疗后3周的中性粒细胞减少的开始时间、持续时间和结束时间,比较两组患儿化疗3周后在白细胞降低发生率、中性粒细胞减少症(FN)发生率及不良反应发生率。结果 化疗3周后,两组患者的ANC、WBC水平均较化疗前升高,且观察组患儿的ANC、WBC水平分别为(6.77±4.22)×10⁹/L、(9.17±3.36)×10⁹/L,均明显高于对照组[(6.34±2.34)×10⁹/L、(8.91±3.56)×10⁹/L],差异均有统计学意义(P<...     

瑞白治疗恶性肿瘤化疗所致的白细胞减少

目的:观察rhGCSF(瑞白)治疗恶性肿瘤化疗所致白细胞减少的疗效和不良反应。方法:用瑞白治疗32例恶性肿瘤化疗所致的白细胞减少症。白细胞计数(WBC)<3.9×109/L或中性粒细胞<2.5×109/L时开始用rhGCSF150μg皮下注射,每日一次,连用5d或以上,白细胞记数升至正常或以上时停药。结果:治疗后可使化疗后白细胞减少患者的白细胞恢复正常范围,平均6.5d,使化疗按期完成。结论:可有效的治疗化疗所致的白细胞减少症,明显缩短白细胞降至正常范围以下的持续时间,有利于化疗的顺利进行。     

基因重组人粒细胞集落刺激因子预防化疗所致白细胞减少79例临床观察

基因重组人粒细胞集落刺激因子（rhG——CSF）刺激粒细胞形成（cfu——G）向粒细胞集落形成单位（cfu——G）进而促进中性粒细胞的增加，我们观察79例rhG——CSF预防“DF”、“NP”方案化疗所致白细胞减少有明显疗效。现将结果报告如下：     

粒生素促进恶性肿瘤病人化疗引起的白细胞减少症的恢复

~~粒生素促进恶性肿瘤病人化疗引起的白细胞减少症的恢复@李志玖$湖北省郧阳医学院附属太和医院肿瘤科!十堰442000 @莫正英$湖北省郧阳医学院附属太和医院肿瘤科!十堰442000 @熊奎$湖北省郧阳医学院附属太和医院肿瘤科!十堰442000~~~~~~     

Effects of biochemically confirmed smoking cessation on white blood cell count

OBJECTIVES: To determine the relationship between white blood cell (WBC) Indices and several baseline variables In a large cohort of healthy smokers and to assess whether these changed after biochemically confirmed smoking cessation. SUBJECTS AND METHODS: The study consisted of 784 healthy smokers enrolled in a trial of sustained-release bupropion, 300 mg/d, for relapse prevention after smoking cessation from 1995 to 1998. Both WBC counts and absolute neutrophil counts (ANCs) were measured at baseline, week 7, and week 52. Smoking status was assessed at weeks 7 and 52 by self-report and biochemically confirmed with expired air carbon monoxide levels. Multivariate analyses compared changes in WBC count and ANC between smokers who did and did not stop smoking, adjusting for treatment group, age, sex, and body mass index. RESULTS: Of 784 smokers enrolled, 461 had biochemically confirmed tobacco abstinence after 7 weeks of bupropion; 429 were randomly assigned to receive continued bupropion therapy or placebo until week 52. Between baseline and week 7, there was a significantly larger decrease in WBC count in continuously abstinent subjects compared with continuing smokers (adjusted P = .03). At 52 weeks, continuously abstinent subjects, compared with continuing smokers, had a greater decline from baseline in WBC count (1.2 +/- 1.9 x 10(9)/L vs 0.1 +/- 1.9 x 10(9)/L; P < .001) and ANC (1.0 +/- 1.6 x 10(9)/L vs 0.2 +/- 1.5 x 10(9)/L; P < .001). CONCLUSION: Biochemically confirmed tobacco abstinence leads to a rapid and sustained decrease in WBC and ANC, possibly reflecting a decrease In an underlying state of tobacco-induced inflammation.     

环磷酰胺联合重组人粒细胞集落刺激因子动员自体外周血干细胞

目的：观察环磷酰胺（ＣＴＸ）联合重组人粒细胞集落刺激因子对自体外周血干细胞（ＡＰＢＳＣ）的动员效果。方法：ＣＴＸ３．７±０．２ｇ／ｍ＾２第１天静滴，白细胞（ＷＢＣ）降至最低点时开始皮下注射ｒｈＧ－ＣＳＦ４．５±０．６μｇ．ｋｇ＾－１．ｄ＾－１，直至采集结束前一天，ＷＢＣ恢复至２．５×１０＾９／Ｌ以上时开始连日采集ＡＰＢＳＣ，采集用ＣＳ３０００ｐｌｕｓ或Ｃｏｂｅ血细胞分离机，当累计采集的单个核细胞（     

Hematopoietic progenitor cell large volume leukapheresis (LVL) on the Fenwal Amicus blood separator

A technique for large volume leukapheresis (LVL) for hematopoietic progenitor cell (HPC) collection using the Fenwal Amicus is presented. It was compared to standard collections (STD) with regard to CD34+ cell yields and cross-cellular content. Optimal cycle volumes and machine settings were evaluated for LVL procedures. A total of 68 patients underwent 80 HPC collection procedures. Because of differences in CD34+ cell yields associated with peripheral white blood cell counts (WBC), the comparison was divided into groups of 20 with WBC < or =35 x 10(9)/L (< or =35 K) and those >35 x 10(9)/L (>35 K). Baseline CD34+ cell counts (peripheral count when patient started HPC collection) were used (median 18-23 cells/microl). Significantly more whole blood (corrected for anticoagulant) was processed with LVL (LVL 20 l vs. STD 13.5 l). For < or =35 K, median CD34+ x 10(6), WBC x 10(9), RBC ml, Plt x 10(11) yields/collection were 183, 21.2, 14, 0.8, respectively, for STD vs. 307, 22.1, 11, 1.0, respectively, for LVL. For >35 K, median CD34+ x 10(6), WBC x 10(9), RBC ml, Plt x 10(11) yields/collection were 189, 32.7, 15, 1.4, respectively, for STD vs. 69, 40.8, 21, 1.3, respectively, for LVL. We have described a method of LVL using the Amicus that, in patients with pre-procedure WBC < or =35 x 10(9)/L, collects more CD34+ cells than a standard procedure with acceptable cross-cellular content. This method is not recommended when pre-procedure WBC counts are >35 x 10(9)/L.     

MAG方案对恶性血液病患者造血干细胞动员作用的研究

目的　研究米托蒽醌 (MTZ)联合大剂量阿糖胞苷 (Ara C)、重组人粒细胞集落刺激因子(rhG CSF)组成MAG方案对恶性血液病患者外周血干细胞的动员作用。方法　 1995年 12月至2 0 0 3年 4月 ,采用MAG方案对 14例恶性淋巴瘤和 2 9例急性白血病患者外周血干细胞进行动员 ,其用量为MTZ 10mg/m2 ,第 2 ,3天 ;Ara C 2 g/m2 ,每 12h 1次 ,第 1,2天 ;rhG CSF 30 0 μg/d。首先用MA方案联合化疗 ,白细胞 <1.0× 10 9/L时开始用rhG CSF ,白细胞回升时用CS 30 0 0plus或CobeSpectra血细胞分离机采集外周血干细胞。结果　 14例恶性淋巴瘤患者除 1例外周血干细胞采集失败外 ,其余 13例均 1次性采集成功 ,所得单个核细胞 (MNC) (3.91± 2 .70 )× 10 8/kg ,CD34 细胞 (17.79± 12 .90 )× 10 6/kg。采集 2 9例急性白血病患者外周血干细胞平均 2 .13次 ,2 4例采集成功 ,5例采集失败 ,所得MNC (3.6 2± 2 .89)× 10 8/kg ,CD34 细胞 (7.37± 6 .6 0 )× 10 6/kg。rhG CSF平均使用时间为 7d。经MAG方案动员后 ,除 8例患者有胃肠道反应、14例患者骨髓抑制期合并感染外无明显不良反应 ,无动员相关死亡。MAG方案动员后进行微小残留病检测 ,部分病例转为阴性。结论　MAG方案在恶性淋巴瘤和急性白血病患者外周血干细胞动员中安全     

rhG-CSF和rhSCF对正常猴外周血白细胞和CFU-GM数的影响

为了观察重组人干细胞因子 (rhSCF)和 (或 )粒细胞集落刺激因子 (rhG CSF)动员外周血干细胞的效果 ,本研究将 15只正常成年猕猴分成 3组 ,每天 1次 ,连续 14天分别皮下注射赋形剂、rhG CSF 10 μg/ (kg·d)和rhSCF5 0 μ/ (kg·d) +rhG CSF 10 μ/ (kg·d)。结果表明 ,单独给rhG CSF组的外周血白细胞数最高值在给药后第 7天出现 ,为给药前值的 4 11% ,其后很快下降。联合给药组外周血白细胞数最高值在第 9天出现 ,为给药前值的 5 38% ,第 7至第 9天的外周血白细胞数在 5 35 % - 5 38%之间。单独给药组外周血CFU GM最高值在给药后第 5天为给药前值的 937% ,联合给药组在第 9天为 1175 %。结论 :rhG CSF对外周血干 /祖细胞有明显的动员作用 ,rhSCF +rhG CSF联合动员的效果优于rhG CSF单用     

Zuclopenthixol-associated neutropenia and thrombocytopenia

OBJECTIVE: To report a case of neutropenia and thrombocytopenia secondary to use of zuclopenthixol in a schizophrenic patient. CASE SUMMARY: A 66-year-old white man with chronic schizophrenia was referred to the hospital due to neutropenia and thrombocytopenia that developed shortly after initiation of zuclopenthixol therapy. Prior to zuclopenthixol administration, his white blood cell and platelet counts were 8.5 x 10(9) cells/L3 and 305 cells x 10(9)/L, respectively. Progressive reduction in leukocyte and platelet counts occurred, reaching a nadir of 2.9 x 10(9) cells/L3 (granulocytes 18.9%) and 109 cells x 10(9)/L, respectively. Zuclopenthixol was discontinued on admission, resulting in complete recovery within the next five days. DISCUSSION: Neutropenia and thrombocytopenia are well-known complications of antipsychotic drug therapy. Zuclopenthixol, a well-established antipsychotic agent, has relatively few adverse effects. The rapid decrease of white blood cell and platelet counts following the initiation of zuclopenthixol, as well as the rapid recovery, implicate zuclopenthixol as the predominant cause for neutropenia and thrombocytopenia in this patient. CONCLUSIONS: Although neutropenia and thrombocytopenia are rare complications of zuclopenthixol therapy, monitoring blood counts in patients receiving this agent seems to be justified.     

Automated immature reticulocyte counts are early markers of engraftment following autologous PBSC transplantation in patients with lymphoma

The traditional indicators of engraftment following PBSC transplantation (PBSCT) are the rising total WBC count and ANC. Reticulocytes may be an earlier indicator, since as reticulocytes mature, there is a gradual loss of cellular RNA, which can be measured using methylene blue and light scatter with an Abbott CD 3500 automated counter (Abbott Laboratories, Maidenhead, U.K.). Reticulocytes can be divided into three fluorescence ratios depending on the amount of light scatter generated, high, medium, and low. The most immature are the high fluorescence reticulocytes (HFR). Standard engraftment parameters together with HFR were measured in a homogeneous group of 25 patients with lymphoma after PBSCT using a standard conditioning protocol. An ANC of 0.5 x 10(9)/L was achieved after a median of 10 days (mean 11.2 days, range 9-22). The recovery of the HFR to 2% of the total reticulocytes was significantly shorter, with a median of 8 days (mean 7.5 days, range 6-10) (p < 0.0001). The values of HFR to 2% preceded the ANC of 0.5 x 10(9)/L in 24 of the 25 patients by a median of 3 days (mean 3.8 days, range 2-12 days). On this basis, it can be determined that in 96% of cases, engraftment was indicated earlier by HFR measurement. The HFR to 2% even preceded the ANC of 0.1 x 10(9)/L in 23 of the 25 patients, showing that engraftment was indicated earlier in 92% of patients. Immature reticulocytes appearing in peripheral blood can be reliably measured by automated cytometers, and HFR can, therefore, be used as an earlier indicator of engraftment following PBSCT. This information provides the opportunity for earlier cessation of antibiotics and growth factors and could lead to earlier discharge from hospital, with cost savings.