Leukemoid reactions in children: types (types), causes, algorithm of diagnosis, treatment. Leukemia reactions and leukemia: differences

Leukemoid reactions - changes in hemopoiesis, similar to the picture of blood in leukemias and other tumors of the hematopoietic system. It should be noted that the specificity of these effects is their active focus and the lack of a transition to oncological pathology. These reactions can be triggered by various kinds of intoxications, tumors, infections, metastases of brain cancer.

The mechanism of development is different for different types of reactions: in some cases it is an exit into the blood of immature cellular elements, in others - increased production of blood cells or restriction of the cells' exit into tissues, or the presence of several mechanisms simultaneously.

What can be the source of the disease?

There are many factors that can lead to leukemoid reactions. The reasons for their development are:

• The effect of ionizing radiation;
• tuberculosis;
• sepsis;
• Purulent processes;
• dysentery;
• Lymphogranulomatosis;
• Trauma to the skull;
• Shock state;
• Croupous pneumonia;
• Face;
• diphtheria;
• scarlet fever;
• Acute dystrophy of the liver;
• Therapy with corticoid hormones;
• Carbon monoxide poisoning.

Varieties of the disease

There are the following types of leukemoid reactions:

• Myeloid reactions.
• Lymphocytic.
• Pseudoblastic.

Let's consider each of them in more detail.

Myeloid

This type of reaction includes such reactions as neutrophilic, promyelocytic and eosinophilic. Leukemoid effects, similar to chronic myeloid leukemia, are accompanied by intoxications and severe infections. Active leukocytosis is basically a complex process, accompanied by the presence of sepsis, inflammatory foci and an increase in body temperature.

Exposure to excess 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 similar to erythremia. Factors of erythrocytosis are often malaises of the lungs with a decrease in oxygenation (oxygen saturation) of blood, kidney tumors, and congenital heart defects. In this situation, computer and ultrasound examination is required.

Myeloma is similar to acute erythromyelosis, which differs only in the lack of blastic red blood cells in the bone marrow and blood. Often, it can be detected with metastases of the disease in the bone.

Lymphocytic

Such reactions are characterized by a significant increase in the total number of lymphocytes in the peripheral blood, which is often responsible for the increase in the liver, lymph nodes and spleen.

This type includes mononucleosis, infectious lymphocytosis, monocyte-macrophage leukemia reactions in children with bacterial, viral infections, as well as parasitic infections and large eosinophilia of blood (for example, with helminthiasis).

Lymphocytic reactions appear:

• In viral infections (chicken pox, rubella, epidemic parotitis, adenovirus infection, measles, infectious mononucleosis);
• Parasitic infections (rickettsiosis, toxoplasmosis, chlamydia);
• Bacterial infections (syphilis, pertussis, tuberculosis);
• Different mycoses;
• Autoimmune diseases (serum disease, systemic lupus erythematosus).

Lymphocytic type is still found in Waldenstrom's macroglobulinemia, inflammatory processes, sarcoidosis. All of the above ailments are treated very hard and can bother the patient for more than one year.

Pseudomonas

Such leukemoid reactions occur if the patient is just starting to emerge from immune agranulocytosis, the cause of which can be caused by the intake of sulfonamides, "Amidopyrina", "Butadione" and other drugs.

For such a group of influences, the presence of a considerable number of cellular components with a homogeneous nucleus, single nucleoli and blue, thin, non-granular cytoplasm, is present in the peripheral blood and bone marrow.

Unlike the characteristic blastic red blood cells in these there is no specific soft network and the dimensionality of the chromatin fibers. Unstable blastoses disappearing without chemotherapy and related to leukemoid effects are found in newborn babies with genetic chromosome abnormalities (for example, Down's syndrome).

Leukemoid reactions, the types of which were presented above, formed against the background of any pathology, usually do not provoke dangerous complications. Sometimes abruptly appeared 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 the precisely determined lines of the follicles, is of considerable significance.

Leukemia reactions and leukemia: differences

There are some differences between such influences and leukemia, namely:

1. 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 leycoerythroblastic ratio of 3: 1 and 4: 1.
2. There is no manifestation of anaplasia in leukemoid events, as is the case with leukemia, when protoplasm protrusion and anomaly of the nucleus occur.
3. 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, with leukemia the content of mature neutrophils decreases, and excessive proliferation of young, immature forms occurs.
4. When leukemoid reactions are often observed toxic granularity of neutrophils.
5. In the cytochemical study of leukocytes in leukemia, a decrease or absence of alkaline phosphatase is observed , with leukemoid reactions - increased activity.
6. With exacerbation of chronic myelogenous leukemia, a blast crisis is a precursor of the eosinophilic-basophilic association, with leukemoid reactions it is absent.
7. With myeloleukemia, a high thrombocytosis is often observed, with leukemoid reactions, the number of platelets is within the normal range.
8. At the initial stages of chronic myelogenous leukemia, a large dense spleen is found, with leukemoid reactions sometimes also splenomegaly, but this organ is soft and never reaches very large sizes.
9. When leukemoid reactions to the neoplastic process in the bone marrow are detected cancer cells.

Leukemoid reactions in children: a diagnostic algorithm

An important role in the diagnosis of this disease is assigned to the pathologist, who examines the biopsy material. But in order to avoid an irreparable mistake, the pathologist must collect reliable information about the patient, give him a referral to various tests and prescribe a cytostatic treatment that will remove all the effects of lymphadenitis. If all this is not done, then the diagnosis will be incorrect, and therefore it will be very difficult to cope with the disease. After all, such a disease is very dangerous. Sometimes for the details of the imprisonment it is necessary to perform a repeated biopsy.

A significant value in the diagnosis is a smear from the exterior of the biopsy lymph node and imprint. With lymphosarcoma, most of the red blood cells (at least 30 percent) are permanent blast cells. With immunoblastic lymphadenitis, such erythrocytes, as a rule, are less than 10 percent, they are different in terms of basophilia of cytoplasm and maturity of the nucleus.

Pathohistological diagnosis of lymph node analysis should be very detailed and preclude an inaccurate conclusion. Because the pathologist for various blood tests should clearly determine the diagnosis, and this is reflected in the conclusion. For example, to establish a primary diagnosis of benign lymphomas in some cases, it takes a long time to observe the patient and to examine the lymph nodes again.

Diagnosis of leukemoid reactions suspected of detecting a monoclonal immunoglobulin sometimes requires long-term observation and repeated bone marrow puncture. Before the approval of the diagnosis, antitumor treatment is contraindicated.

Infectious mononucleosis

Also called the Filatov-Pfeiferra disease, glandular fever and monocytic angina. It is a viral disease characterized by blast-transformation of lymphocytes, enlarged lymph nodes and spleen, reactive lymphadenitis, the appearance of specific red blood cells in the peripheral blood. The causative agent is the Epstein-Barr virus. At the base of the disease is the blast-transformation of lymphocytes caused by a particular viral infection.

The clinical situation is different. In mild forms, the state of health is disturbed due to rhinitis. Indicative features:

• Angina ("burning sores");
• Enlargement of the spleen and cervical lymph nodes, as well as their soreness;
• Difficult nasal breathing in the early days of the disease due to the swelling of the mucous membrane.

Blood condition: increased percentage of eosinophils, lymphocytes and monocytes.

Complications

Sufficient and sufficient for concluding the indicator of the disease is the presence in the blood of peculiar mononuclears (more than 10-20%) - cells differing in the nucleus of a large lymphocyte and a broad basophilic with a lilac color cytoplasm with pronounced perinuclear clearance. There are leukemoid reactions in children and adults for several weeks, but in certain situations the normalization of the blood condition continues for months.

Relapses with lighter flow are also observed, sometimes at intervals of several years after the first acute period. Complications can be:

• Acute hepatitis;
• encephalitis;
• Agranulocytosis;
• Spleen rupture caused by its rapid increase;
• Autoimmune hemolysis.

Therapy of leukemoid reactions

As a rule, patients do not need special medicinal treatment, because for several days the main signs of the disease disappear and the blood state is normalized. With prolonged illness and poor health of the patient, pathogenetic therapy is used - prescribe "Prednisolone" in a dosage of 20-30 milligrams per day or other glucocorticoid drugs to eliminate leukemoid reactions. Treatment in any case appoints only a specialist.

Forecast

Usually positive: contagiosity is low, and therefore patient quarantine is optional. However, ruptures of the spleen are very dangerous . Restoration of efficiency is determined by the appearance of signs of a reduction in body volume, as well as the disappearance of sore throats and normalization of body temperature. If infectious mononucleosis is manifested in the form of hepatitis, hospitalization of the patient is required.