BNH BCH CU CP - UNG TH MU

8 Thng 3 2014 lc 9:25

Bch cu cp l bnh c tnh ca t chc to mu (tu xng v cc c quan to mu
khc) sn sinh ra mt s lng ln mt vi loi bch cu cn non hay bt thng gy ri
lon qu trnh sinh sn v pht trin ca dng bch cu bnh thng, ln t dng hng cu
v tiu cu, dn ti :
-Mn cm vi cc bnh nhim v gim bch cu trung tnh.
-Thiu mu
-Xut huyt v b gim tiu cu.
-To lch, to gan v nhiu hch bch huyt.

Bch cu cp nht l Bch cu cp th lymph l bnh ung th ph bin nht tr di

15 tui, chim 1/3 tng s ung th mc hng nm tr em. Bch cu cp th tu gp
nhiu c tr em ln ngi ln.

Nguyn nhn gy bnh cha c tm hiu mt cch r rng v y , nhng c nhiu

bng chng nu ln vai tr ca cc tia phng x, mt s loi thuc, virus HTLV (human
T-cell lymphotropic virus),

Bnh c 2 th ch yu l : Bch cu cp th lymph (Acute lymphocytic leukaemia

ALL) v Bch cu cp th tu (Acute myelogenous leukaemia AML).

HI CHNG LM SNG

Bch cu cp c 3 hi chng lm sng l : nhim khun, xut huyt v u hch.

-Hi chng nhim khun : St, mch nhanh, mi kh, li bn, i t, mt mi km n,
thng c lot km gi mc trng ln cht hoi t nim mc li, khoang ming.
-Hi chng xut huyt : c th biu hin :

+Di da : chm, mng, ri rc khp c th.

+Nim mc : chy mu cam, chy mu chn rng, i ra mu, a ra mu.
+Ni tng.
+Bnh nhn xanh xao, da nim mc nht nht theo mc xut huyt nhiu t. Tim c
th nghe thy ting thi tm thu.
-Hi chng u, hch:
+Hch to c nhiu ni : nch, c, bn, trung tht c 2 bn, to nh khng u, khng
au, mm, di ng; hay gp nht Bch cu cp th lymph.
+Gan lch cng to ra, khng au.
+au xng, au khp, u xng, c th c u hc mt y nhn cu li ra.

XT NGHIM CN LM SNG

Xt nghim huyt hc-huyt v nht l xt nghim tu rt cn thit cho chn on

xc nh.
-Huyt :
+Hng cu, huyt cu t, hng cu li u gim.
+Bch cu c th tng cao hoc gim nhng bch cu trung tnh gim nng; C nhiu
nguyn bch cu, nguyn bo lymph, nguyn tu bo tu theo ALL hay AML.
+Tiu cu gim.
-Tu : Xt nghim dch no tu bng chc vng tht lng v ly tm :
+S lng t bo tu tng sinh mnh, song cng c khi gim.
+Ba dng t bo tu : hng cu, bch cu ht, mu tiu cu b gim nng.
+Tng sinh cc nguyn bch cu (leucoblastes).
-Siu m bng : xem kch thc v cu trc : gan, lch, thn, hch.

-Sinh ho mu : chc nng ng mu, creatinin mu, acid uric, LDH, men gan, cc loi
HLA, khng nguyn khng bnh bch cu.

PHN LOI :

Da theo hnh thi hc v mt s phn ng ho hc t bo, ngi ta phn loi cc th ca

Bch cu cp. Hu ht cc nc phn loi theo FAB (French-American-British) :
-Bch cu cp th lymph-ALL :
+L1 : t l (TL) 86%; hnh thi t bo (HTTB) : t bo nh, t nguyn sinh cht, ht nhn
khng r.
+L2 : TL 13%, HTTB : t bo ln, nhiu nguyn sinh cht, mng nhn khng u.
+L3 : TL 1%; HTTB : nguyn sinh cht bt kim mnh, km vi nhiu khng bo.
-Bch cu cp th tu-AML :
+M1 : TL 20%, HTTB : Nguyn tu bo t bit ho.
+M2 : TL 29%, HTTB : Nguyn tu bo bit ho.
+M3 : TL 7%, HTTB : Tin tu bo.
+M4 : TL 22%, HTTB : Th tu bo v bch cu n nhn.
+M5 : TL 19%, HTTB : Nguyn bch cu n nhn.
+M6 : TL 1%, HTTB : Nguyn hng cu.
+M7 : TL 2%, HTTB : Nguyn t bo nhn khng l.