CYTOPENIA

From Big Medical Encyclopedia

TsITOPENYYa (cytopenia; Greek kytos a receptacle, here — a cell + penia poverty) — the lowered maintenance of uniform elements in blood.

Distinguish an erythrocytopenia (adults have a reduction of quantity of erythrocytes less than 4 OOO OOO in 1 mkl), thrombocytopenia (adults have a decrease in quantity of thrombocytes less than 150 000 in 1 mkl), a leukopenia (adults have a reduction of quantity of leukocytes less than 4000 in 1 mkl) and a pancytopenia (decrease in number of all uniform elements of blood). These types of C. can meet separately or in various combinations (in the latter case speak about dvukhrostkovy or trekhrostkovy cytopenias). The leukopenia (see) is most often connected with reduction in blood of absolute quantity of neutrophils (adults have less than 2000 in 1 mkl), i.e. with a neutropenia, is more rare with a lymphopenia (adults have a quantity of lymphocytes less than 1200 in 1 mkl), is even more rare with a monocytopenia (adults have a quantity of monocytes less than 90 in 1 mkl); the lowered maintenance of eosinophilic and basphilic granulocytes in blood practically does not affect total quantity of leukocytes.

Origins of C. are various. So, allocate C., developed as a result of reduction of products of the hemopoietic cells in red marrow that is observed at hypoplastic anemia (see), nek-ry forms of inborn cytopenias, at a cytostatic disease (see Leukoses) and leukemic infiltration of red marrow, metastasises of cancer in marrow, deficit of various hemopoietic factors, etc. Cytopenias can be caused by the slowed-down exit of blood cells from red marrow that occurs at a syndrome of lazy leukocytes (sharp braking of their physical activity), at a number of hereditary neutropenias (see Neutropenias hereditary), at defeat of cellular membranes nek-ry himiopreparata. C. result from reduction of time of circulation of cells in a circulatory bed that is noted at autoimmune and isoimmune forms of hemolitic anemia (see), trombotsitopeniye (see), an agranulocytosis (see), splenogenny cytopenias (see the Spleen), a megaloblast - ache anemias (see. Pernicious anemia), nek-ry trombotsitopatiya (see), various forms of not immune hemolitic anemias (see. Hemolitic anemia) and the cytopenias caused by various heavy infectious and extensive inflammatory processes. C. can be connected with redistribution of blood cells in a vascular bed and (or) their absorption at an intravascular blood coagulation, napr, at stressful and depressed cases, a hypervolemia, massive hemotransfusions (see Hemotransfusion), a syndrome of the disseminated intravascular coagulation (see. Hemorrhagic diathesis), etc.

At establishment of C. make a research of red marrow for clarification of its origin (see Miyelogramm), apply direct or indirect tests for identification of the corresponding antibodies, napr, Koombs's test (see Koombs reaction), etc.

Treatment at C. it is directed to a basic disease.

A cytopenia at children. Indicators of blood at children (is normal also at pathology), according to various researchers, have the broad range of fluctuations. The quantity of uniform elements of blood at children, by results of a gemogramma, changes depending on age and the weight of the child (see Blood). Lability of indicators of blood, especially at children of early age, is caused by incompleteness of a hemopoiesis and imperfection of endocrine, immune systems and a cerebral cortex.

At children of C. can be as acquired, and constitutional, but it is more often it is connected with hereditary and inborn factors. So, at early children's age the erythrocytopenia at partial hypoplastic anemia of Dzhozefs meets — Daymonda — Blekfena (see. Hypoplastic anemia), at a cut, according to nek-ry researchers, there is genetically caused disturbance of exchange of tryptophane (see), and also antibodies against cells of an erythroidal number of marrow are found. At other form of hypoplastic anemia — Fankoni's anemias, edge develops at children of 5 — 7 years more often, disturbance of all sprouts of a hemopoiesis with decrease not only in erythrocytes, but also leukocytes and thrombocytes of blood is observed.

At children the erythrocytopenia can be caused by also increased hemolysis, e.g., at micro spherocytic hemolitic anemia, ovalotsitarny hemolitic anemia (see. Hemolitic anemia), thalassemias (see), at deficit of a glyukozo-6-phosphate-dehydrogenase (see Enzimopenichesky anemia). Erythrocytopenias at newborns are observed at incompatibility of antigens of erythrocytes of mother and child (see. Hemolitic disease of newborns).

Rapid growth of the child at early age demands the increased synthesis of hemoglobin and a hypermetabolism of iron therefore at improper feeding there can be a deficit folic to - you and B12 vitamin therefore the erythrocytopenia develops.

Unlike adults of an erythrocytopenia at children are less often connected with blood losses, except for hemorrhagic diathesis (see).

From hereditary diseases of system of blood at children neutropenias, to-rye as believe are observed, are caused by disturbance of migration of neutrophils, their phagocytal activity owing to decrease of the activity of an alkaline phosphatase and increase in acid phosphatase (see Neutropenias hereditary).

Among the acquired C. most often immune cytopenias — autoimmune hemolitic anemias, neutropenias (see the Leukopenia)) and thrombocytopenia meet (see Thrombocytopenia). Often they proceed sharply and are observed after focal infection. Tran-zitorny neutropenias and thrombocytopenia at newborns as a result of presence of maternal agglutinins to blood cells are described.

Treatment of a basic disease is carried out.

Bibliography: And l of m and z about in V. A., etc. Leukopenias, L., 1981; Goldberg D. I., and Goldberg E. D. The reference book on hematology with the atlas of microphotograms, Tomsk, 1980; Kassirsky I. A. and Alekseev G. A. Clinical hematology, M., 1970; To and with l I to N. S.

and L e N with to and I am R. V. A blood cell at children it is normal also of pathology, M., 1978; Mos I am and N and E. N, Torubarovan. And., and Vladimir E.B. Diseases of blood at children, the Atlas, M., 1981; New in hematology, under the editorship of A. I. Vorobyov and Yu. I. Loriye, M., 1974; The Guide to hematology, under the editorship of A. I. Vorobyov and Yu. I. Loriye, M., 1979; Feinstein F. E. and d river. Diseases of system of blood, Tashkent, 1980.

R. A. Mokeeva; L. A. Makhonova (ped.).

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