Leukemoid reactions - changes in hematopoiesis, similar to the blood picture in leukemia and other tumors of the hematopoietic system. It should be noted that the specificity of these effects is considered to be their active orientation and the absence of a transition to oncological pathology. These reactions can be triggered by various types of intoxication, tumors, infections, brain cancer metastases.
The mechanism of development is not the same for different types of reactions: in some cases it is the release of immature cellular elements into the blood, in others - an increased production of blood cells or a restriction of the release of cells into tissues, or the presence of several mechanisms at the same time.
What could be the source of the disease?
There are many factors that can cause leukemoid reactions. The reasons for their development are:
- effect of ionizing radiation;
- tuberculosis;
- sepsis;
- purulent processes;
- dysentery;
- lymphogranulomatosis;
- injuriesskull;
- shock condition;
- croupous pneumonia;
- mug;
- diphtheria;
- scarlet fever;
- acute liver dystrophy;
- corticoid hormone therapy;
- carbon monoxide poisoning.
Disease types
The following types of leukemoid reactions are distinguished:
- Myeloid reactions.
- Lymphocytic.
- Pseudo-regional.
Let's consider each of them in more detail.
Myeloid
This type includes reactions such as neutrophilic, promyelocytic and eosinophilic. Leukemoid effects, similar to chronic myeloid leukemia, are accompanied by intoxication and severe infections. Active leukocytosis at its core always has a complex process, accompanied by the presence of sepsis, inflammatory foci and an increase in body temperature.
Exposures with an excess of eosinophils in the blood, as a rule, occur with sensitization to parasites and drugs, allergic diathesis, rarely - with oncological diseases (lymphogranulomatosis and lymphosarcoma). These leukemoid reactions need a comprehensive examination to eliminate diseases of the circulatory system and helminths.
Reactive cells are like erythremia. Erythrocytosis factors are often lung ailments with a decrease in oxygenation (oxygen saturation) of the blood, kidney tumors, and congenital heart defects. In this situation, a computer and ultrasound examination is required.
Myelemia is similar to acute erythromyelosis,which differs only in the lack of blast erythrocytes in the bone marrow and blood. Often it can be found in bone metastases of the disease.
Lymphocytic
Such reactions are characterized by a significant increase in the total number of lymphocytes in the peripheral blood, which is often responsible for an increase in the liver, lymph nodes and spleen.
This type includes mononucleosis, infectious lymphocytosis, monocyte-macrophage leukemoid reactions in children with bacterial, viral infections, as well as parasitic infections and large blood eosinophilia (for example, with helminthiasis).
Lymphocytic reactions appear:
- for viral infections (chickenpox, rubella, mumps, adenovirus infection, measles, infectious mononucleosis);
- parasitic infections (rickettsiosis, toxoplasmosis, chlamydia);
- bacterial infections (syphilis, whooping cough, tuberculosis);
- various mycoses;
- autoimmune diseases (serum disease, systemic lupus erythematosus).
The lymphocytic type is also found in Waldenström's macroglobulinemia, inflammatory processes, and sarcoidosis. All of the above ailments are treated very hard and can bother the patient for more than one year.
Pseudo-regional
Such leukemoid reactions occur if the patient is just starting to recover from immune agranulocytosis, the cause of which may be caused by taking sulfonamides, Amidopyrine, Butadion and other drugs.
This group of influences is characterized by the presence in the peripheral blood and bone marrow of a considerable number of cellular components with a homogeneous nucleus, single nucleoli and a blue, thin, non-granular cytoplasm.
Unlike the characteristic blast erythrocytes, these do not have a specific soft network and regularity of chromatin fibers. Intermittent blastoses that disappear without chemotherapy and are related to leukemoid effects are found in newborn babies with genetic chromosome disorders (eg, Down syndrome).
Leukemoid reactions, the types of which were presented above, formed against the background of any pathology, usually do not provoke dangerous complications. Sometimes abrupt thrombocytopenia can be mistakenly regarded as one of the signs of acute leukemia. In the detection of immunoblastic lymphadenitis, the safety of the natural structure of the lymph node, as well as precisely defined lines of follicles, is of considerable importance.
Leukemoid reactions and leukemia: differences
There are some differences between these exposures and leukemia, as follows:
- With leukemoid reactions, there is no rapid rejuvenation of the bone marrow, it is metamyelocytic, and with leukemia, an increase in blast forms is found. With leukemoid effects, the erythroid germ is preserved, there is a normal leukoerythroblastic ratio - 3:1 and 4:1.
- There is no apparent anaplasia in leukemoid phenomena, as is the case with leukemia, whenbulging of protoplasm and anomaly of the nucleus occur.
- In the first variant in the peripheral blood there is an increase in the absolute number and an increase in the percentage of mature neutrophils, in leukemia the content of mature neutrophils decreases, and there is an excessive proliferation of young, immature forms.
- Toxic neutrophil granularity is common in leukemoid reactions.
- In the cytochemical study of leukocytes in leukemia, there is a decrease or absence of alkaline phosphatase, with leukemoid reactions - increased activity.
- Eosinophilic-basophilic association is a precursor of blast crisis during exacerbation of chronic myeloid leukemia, but it is absent in leukemoid reactions.
- In myeloid leukemia, high thrombocytosis is often observed, in leukemoid reactions, the platelet count is within the normal range.
- In the initial stages of chronic myeloid leukemia, a large dense spleen is found, with leukemoid reactions sometimes there is also splenomegaly, but this organ is soft and never reaches very large sizes.
- When leukemoid reactions to a neoplastic process, cancer cells are found in the bone marrow.
Leukemoid reactions in children: diagnostic algorithm
An important role in diagnosing this disease is given to the pathologist who examines the biopsy material. But in order to prevent an irreparable mistake, the pathologist must collect reliable information about the patient, give him a referral tovarious tests and prescribe cytostatic treatment, which will remove all the consequences of lymphadenitis. If all this is not done, then the diagnosis will be made incorrectly, and therefore it will be very difficult to cope with the disease. After all, such a disease is very dangerous. Sometimes a repeat biopsy is necessary for details of the conclusion.
A swab from the outside of a biopsied lymph node and an imprint are of considerable importance in diagnosing. In lymphosarcoma, most of the red blood cells (at least 30 percent) are permanent blast cells. In immunoblastic lymphadenitis, these RBCs are typically less than 10 percent and vary in terms of cytoplasmic basophilia and nuclear maturity.
Pathological diagnosis based on the analysis of the lymph node must be very detailed and exclude inaccurate conclusions. Because the pathohistologist for various blood tests must clearly define the diagnosis, and this is reflected in the conclusion. For example, to establish the primary diagnosis of benign lymphomas, in some cases, it is required to observe the patient for a long time and examine the lymph nodes again.
Diagnosis of leukemoid reactions, suspected by the detection of monoclonal immunoglobulin, sometimes requires many years of observation and repeated bone marrow punctures. Until the diagnosis is confirmed, anticancer treatment is contraindicated.
Infectious mononucleosis
Also called Filatov-Pfeifer disease, glandular fever and monocytic tonsillitis. Isa viral disease characterized by blast transformation of lymphocytes, enlarged lymph nodes and spleen, reactive lymphadenitis, the appearance of specific erythrocytes in the peripheral blood. The causative agent is the Epstein-Barr virus. The basis of the disease is the blast transformation of lymphocytes caused by a specific viral infection.
The clinical situation is different. In mild forms, well-being is disturbed due to rhinitis. Indicative signs:
- angina ("burning pharynx");
- enlargement of the spleen and cervical lymph nodes, as well as their soreness;
- difficult nasal breathing in the first days of the disease due to swelling of the mucous membrane.
Blood status: increased percentage of eosinophils, lymphocytes and monocytes.
Complications
A necessary and sufficient indicator of the disease for the conclusion is the presence in the blood of peculiar mononuclear cells (over 10-20%) - cells that differ in the nucleus of a large lymphocyte and a wide basophilic lilac-colored cytoplasm with pronounced perinuclear enlightenment. Leukemoid reactions last for several weeks in children and adults, but in certain situations, the normalization of the blood state takes months.
Relapses are also observed with a milder course, sometimes at intervals of several years after the first acute period. Complications can be:
- acute hepatitis;
- encephalitis;
- agranulocytosis;
- rupture of the spleen due to its rapid enlargement;
- autoimmunehemolysis.
Therapy for leukemoid reactions
As a rule, patients do not require special drug treatment, because within a few days the main signs of the disease disappear and the blood condition returns to normal. With a protracted illness and poor he alth of the patient, pathogenetic therapy is used - Prednisolone is prescribed at a dosage of 20-30 milligrams per day or other glucocorticoid drugs to eliminate leukemoid reactions. In any case, only a specialist prescribes treatment.
Forecast
Usually positive: contagiousness is low and therefore patient quarantine is not necessary. However, ruptures of the spleen are very dangerous. Recovery of working capacity is determined by the appearance of signs of a reduction in the volume of the organ, as well as the disappearance of tonsillitis and the normalization of body temperature. If infectious mononucleosis manifests itself in the form of hepatitis, hospitalization of the patient is required.
