Acute Reticulosis
(Internal Disease - Circulatory)
Acute reticulosis - a form of acute leukemia characterized by a hyperplastic process involving the reticular tissue of the stroma-forming organs and by aleukemic blood picture, in which the undifferentiated and immature hematopoietic elements do not enter the peripheral blood, or get it in small quantities.
Symptoms and flow. Is rare and occurs usually in the absence of clinical symptoms of hyperplasia of hematopoietic organs, but with rapidly progressive pancytopenia. It is characterized by sudden fever appears to 39-40, severe intoxication, sharp pains in the bones and joints.
According to the clinical picture and the composition of peripheral blood resembles aplastic (hypoplastic) anemia stop difference is that when reticulosis still often possible to identify, albeit slight, increase in the lymph nodes and spleen. Against the backdrop of the destroyed bone marrow observed elevated number of reticular elements found primarily in the form of syncytial fragments.
In some cases, acute reticulosis clinically occurs as a form of leukopenic hemocytoblastosis. At post-mortem examination revealed the widespread proliferation of the reticular elements.
Reticulose, flowing with the leading symptom of anemia, occurs mainly in the form of aleukemic option and only in the last stage of the disease in some cases, a transformation in hemocytoblastosis. In the differential diagnosis to exclude tuberculosis, hroniosepsis, hypoplastic anemia, osteodysplasia, chronic hemolytic anemia, malignant neoplasm.
Reticulose, flowing with predominant tumor growths, characteristic of the foreground rapid growth of blood-forming organs from the destruction of surrounding tissues. In this form of leukemia often manifest a symptoms of hemorrhagic pleurisy, pericarditis and ascites due to the infiltrative growth of tumor formation originating from the lymph nodes or other tissue organs hematopoiesis. Flow is subacute. The characteristic features of tumor-like growths are lymph nodes in the form of a conglomerate of various localization, increased liver and spleen, reaching the usually enormous size. This form of reticulosis identified with the reticuloendothelial (lymphocytes) sarcomatosis.
Blood in aleukemic reticulosis is characterized by reduction of red blood, a tendency to moderate leukocytosis, and thrombocytopenia expressed, however, not so sharp degree, as when hemocytoblastosis. Leucogram represented predominantly granulocytic elements or lymphocytes and monocytes, but more often occurs in the shift to single her immature and undifferentiated forms. If puncture of lymph nodes revealed hyperplasia of the reticular pattern of elements, usually represented as a syncytium or cells resembling hemohistioblast and hemocytoblasts.
Bone marrow punctate pattern shows increased immature and undifferentiated forms, but this increase does not adequately ensure what is observed in hemocytoblastosis. The number of mature granulocytes is reduced. Red sprout in most cases narrowed.
Recognition, especially aleukemic form reticulosis, often presents difficulties because of hemogram and myelogram number of undifferentiated elements is small. In order to clarify the diagnosis must take into account the full range of clinical symptoms, perform a thorough differential diagnosis of diseases such as sepsis, neoplastic process, tuberculosis, brucellosis, tularemia, etc.
In favor of the diagnosis of reticulosis indicates violation of one degree or another all haemopoesis according bone marrow, hyperplasia of reticular elements in the lymph nodes when they puncture or biopsy, and resorption of bone tissue and hyperplasia of reticular elements in preparations trepanobiopsy.
Treatment. Prednisolone at 1.5 mg / kg (an average of 80-60 mg / day) for 10-15 days followed by a gradual decrease in dose of 2.5 mg / 2 days to 30-40 mg per day, and that should be applied to the onset of clinical and hematological improvement. At the tumor forms of reticulosis, if they do not fall under the influence of steroid therapy should be to test the action of chemotherapy drugs, such as Cyclophosphamide of 200-400 mg / day. Heading dose varies widely (up to 3 of 6 g or more). Radiotherapy for local 50-200 daily or every other day.
With the development of anemia appoint transfusion of whole blood at 250 ml, or red blood cells of 125 ml. The frequency of transfusion depends on the degree of anemia. Since hemostatic purpose and to stimulate normal hematopoiesis appoint vitamins B2, B6, P, ascorbic acid, calcium preparations.
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