Mycoplasmal (ureaplasma) septic arthritis in hypogammaglobulinaemia.
Mycoplasmal (ureaplasma) septic arthritis in hypogammaglobulinaemia.
复制标题
低丙种球蛋白血症中的支原体（脲原体）化脓性关节炎。
作者：
A. Webster;D. Taylor;P. Furr;G. Asherson
虽然白细胞通常对血液粘度的贡献很小，但有研究表明，粒细胞对血液粘度的影响比全血粘度测量的结果更大。4此外，白细胞浓度的增加可能会对红细胞的粘度产生很大影响。5几个工作人员已经显示出白细胞的高特性粘度，5 6并且有人提出，慢性粒细胞白血病的一些临床特征可能是由于增加的白细胞质量对粘度的影响。神经系统症状在白血病患者中并不少见。它们可由白血病渗透到中枢神经系统和出血而产生，其中一些因电解质失衡而加重，尤其是在急性粒细胞白血病和慢性粒细胞白血病的急变中。然而，除了没有严重出血外，我们的患者表现出的临床特征与Waldenstrom巨球蛋白血症的常见特征相同，包括听觉和视觉障碍、步态异常和意识改变。事实上，白细胞分离可以迅速消除这些症状和体征，这证明在白血病中，这些症状和体征也可以仅用血液粘度增加来解释；事实上，临床反应，3例为优，1例为部分，与总白细胞计数和全血粘度显著下降有关。髓系白血病患者的神经症状似乎发生在白细胞计数较低的时候，我们发现，这些患者的白细胞计数的给定增加引起的血液粘度的增加比淋巴细胞的类似增加更大。细胞大小几乎肯定是一个重要的因素，尽管可能不是唯一的因素；而且髓系组的MWCV确实明显大于淋巴系组。白细胞分离术是一种非常有效的方法，可以去除大量循环中的白细胞，从而缓解相关的高粘滞症引起的症状。由于这不是一种没有风险的手术，因此应该仔细选择患者。
Although white blood cells normally make little contribution to the viscosity of the blood, it has been suggested that granulocytes have a greater effect on it than whole blood viscosity measurements indicate.4 Increased concentrations of white cells moreover may greatly influence the viscosity of packed red cells.5 Several workers have shown the high intrinsic viscosity of white blood cells,5 6 and it has been suggested that some of the clinical features of chronic granulocytic leukaemia may result from the effects on viscosity of the increased white cell mass.7 Our data suggest that this may be true of several morphological types of leukaemia. Neurological symptoms are not uncommon in patients with leukaemia. They can be produced by leukaemic infiltration into the central nervous system and haemorrhage, and some are accentuated by the electrolyte imbalance found particularly in acute myeloblastic leukaemia and the blast crisis of chronic granulocytic leukaemia. Nevertheless, our patients showed clinical features that were identical, apart from the absence of severe haemorrhage, with those that are common in Waldenstrom's macroglobinaemia, including auditory and visual disturbances, abnormalities of gait, and alterations of consciousness. The fact that leucapheresis could rapidly abolish them is evidence that in leukaemia also these symptoms and signs may be explained solely by increased blood viscosity; and indeed the clinical responses, excellent in three cases and partial in a fourth, were associated with appreciable falls in total white blood count and whole blood viscosity. Neurological symptoms seemed to occur at lower white cell counts in patients with myeloid leukaemias, and we found that a given increment in the white cell count of these patients produced a greater rise in blood viscosity than a similar increase in lymphocytes. Cell size is almost certainly an important factor, though probably not the only one; and the MWCVs were indeed appreciably greater in the myelogenous than the lymphoid group. Leucapheresis is an extremely effective method for removing large numbers of circulating white cells and therefore alleviates the symptoms caused by the associated hyperviscosity. As it is not a procedure without hazard, patients should be carefully selected.