Hematological Aspects of Dengue Fever

民國76年9月至77年1月間經臨床診斷為登革熱之病人50人，其中血清學及病毒學陽性者27人，觀察分析其末稍血液之變化，其中有15位經一星期以上之追蹤檢查，14人接受骨髓檢查，8人行骨髓細胞培養之研究，結果如下：病人年齡由15～71歲平均為33歲，其中男21人，女29人，所有病人末稍血液在病程中之最低平均值為血紅素13.2±1.9g/dl，白血球2770±1634/ mm3，血小板87.4±45.5×103 /mm3，貧血者有21人 (血紅素＜12 g/dl )，白血球減少者 (白血球＜400/ mm3) 38人 (76%)，血小板缺乏者 (血小板＜10×104 /mm3) 27人(54%)，追蹤15位病人之血液像變化可見10位病人，白血球在發病第5～6天降至最低 (1000～2000/ mm3) 後即迅速回升，而有11位病人血小板在第5～7天時降至最低 (20～50×103 /mm3) 後即快速回升，骨髓檢查可見在發病一星期內之病人其骨髓內細胞成份皆有明顯降低，而在發病一星期後之病人其骨髓內細胞成份皆呈現正常，而骨髓內之巨核球在所有受檢病人皆明顯增加，在一病例並可見巨核球之核有空泡崩裂之情形。骨髓細胞培養可見在發病一週內之病人，其群落之成長有明顯之減少，而在發病一週後之病例可見其群落生長大部在正常範圍內，由此結果我們認為登革熱病人在發病一星期內應注意白血球及血小板之降低，至於白血球之降低，可能為病毒直接破壞或抑制了白血球前驅細胞之生長所致，而血小板之降低可能為末稍血液內血小板破壞之增加或病毒破壞巨核球使血小板之產生減少而造成的。

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並列摘要

Fifty patients with dengue fever from Sept. 1987 to Jan. 1988 were studied for hematological features. The lowest blood counts values throughout the course of illness were Hb:13.2±1.9 gm/dl, WBC: (2.77±1.63)×103 /mm3 , Plaatelet: (8.7±5.5)×104 /mm3 . Leukopenia (WBC＜4000/mm3) was present in 38 (76%) of the cases and thrombocytopenia (platelet＜10×104 /mm3) in 27 (54%) of the cases. Leukocytes reached nadir (1000－2000/ mm3) at the 5th－6th day after fever onset, thrombocytes reached nadir (2.0－5.0×104 /mm3) at the 5th－7th day after fever onset. Bone marrow studies showed mild hypocellularity in the acute stage (＜1 week) and normal cellularity in the convalescent stage (＞1 week). Megakaryocytes increased with various stages of maturation of megakaryocytes appearing in a majority of patients. Nuclear vacuolization of megakaryocytes could also be found. Bone marrow CFU-GM when performed within one week of illness showed no growth or low colony count, and was nearly normal after one week of fever onset. This study may suggest that leucopenia in dengue fever may be caused by virus-induced destruction or inhibition of myeloid progenitor cells. Thrombocytopenia may result from by destruction of peripheral platelet or bone marrow megakaryocytes by viruses which consequently reduce the platelet production.

並列關鍵字

dengue fever ； bone marrow ； CFU-GM

國際替代計量

Hematological Aspects of Dengue Fever

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