【DOC】血液科研究室出科考試題 - 醫(yī)學(xué)資源下載
資源作者：下載東西
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上傳日期：2012-12-27 10:01:00

血液科研究室出科考試題 急性白血病鑒別常用的組化有哪些？M2、M5哪些組化陽(yáng)性？ MDS病態(tài)造血骨髓中有哪些改變？ 白血病及MDS常見(jiàn)染色體改變有哪些？ ITP骨髓象特點(diǎn)？ 缺鐵性貧血骨髓象特點(diǎn)？ 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　 　　　　　　　　　　　ANEMIA AND GASTRIC SURGERY 　　　　　　　　　　　Gastrectomy, previously used for peptic ulcer and its complications, is the preferred operation for palliation of gastric cancer either as total or partial gastrectomy.Anemia is a frequent complication of gastrectomy.There are many reports addressing iron, vitamin B12 or folate deficiencies either alone or in combination after gastric surgery. The most frequent is the combination of iron and vitamin B12 deficiency[40]. Impaired absorption of iron following gastrectomy is probably due to operative bypass of the duodenum and to rapid intestinal transit. Reduction in gastric acid (necessary for the absorption of food iron), a common consequence of subtotal gastrectomy, has also been incriminated. Vitamin B12 deficiency develops as a consequence of the decreased production of intrinsic factor which is essential for vitamin B12 absorption in the lower small bowel, and also because of a defect in the separation of vitamin B12 from its transporter protein. It is a frequent deficiency which will appear 2-4 years or even longer after gastrectomy, when the vitamin stores are exhausted. Thus, gastrectomized patients should be followed carefully to avoid iron and vitamin B12 deficiencies and anemia. Over the last few decades, bariatric surgery has been suggested as an effective treatment for obesity. There are several different procedures, including gastric bypass, laparoscopic adjustable gastric banding, vertical banded gastroplasty, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch[41]. All of these procedures may be associated with long-term sequelae including iron, vitamin B12 and folate deficiencies[41,42]. ID and anemia can have a strong impact on quality of life, especially in menstruating women who make up the majority of bariatric surgery patients. Most studies report ID, ranging from 6% to 50% within months to years of followup[43-45]. Vitamin B12 deficiency may appear 1-9 years after gastric bypass, and its prevalence has been estimated to be 12%-33%[42]. The main causes of ID after bariatric surgery are similar to those described after gastrectomy; diminished gastric acid secretion and exclusion of the duodenum. In gastric bypass, patients experience decreased gastric acid production in their proximal pouch and, in addition, the duodenum is excluded from digestive continuity. Thus,banding procedures which maintain digestive continuity with the antrum and duodenum are associated with low rates of ID and other nutritional deficiencies[41].Conversely, the biliopancreatic diversion with duodenal switch, a gastric bypass procedure that may preserve some function of the proximal duodenum, may offer protection from ID, as compared with biliopancreatic diversion (which excludes the duodenum)[46,47]. Physicians should be aware that folate, vitamin B12,and iron deficiencies occur after gastric bypass, though the time to development is variable. In an attempt to prevent nutritional deficiencies, multivitamin preparations are in general prescribed to all patients. Systematic presc**tion of such supplements may prevent most nutritional deficits. However, vitamin B12 and iron deficits require specific supplementation. In spite of a multivitamin, ID still develops postoperatively in some patients. Adherence to oral iron supplements is often low because of digestive intolerance, and unresponsive IDA can be an important problem in these patients. Parenteral iron treatment is recommended in those patients refractory to oral iron supplementation. Intramuscular vitamin B12 supplementation is recommended only when a deficiency becomes clinically apparent. 　　　　　　　　　　　　　　　貧血及胃部手術(shù) 　　　胃切除術(shù)，用于消化性潰瘍及其并發(fā)癥的治療，全部或部分胃切除術(shù)緩解胃癌的首選方法。 　　　貧血是胃切除術(shù)后較為常見(jiàn)的并發(fā)癥。有許多報(bào)告在胃外科手術(shù)后需要治療鐵，維生素B12或葉酸單獨(dú)或聯(lián)合缺乏。最常見(jiàn)的是組合是鐵和維生素B12的聯(lián)合缺乏[40].胃切除后的鐵的吸收不良可能是由于十二指腸繞道手術(shù)，食物迅速通過(guò)腸道過(guò)。胃酸的減少（食物鐵的吸收的必要因素）是胃大部切除術(shù)的常見(jiàn)事件。隨著內(nèi)因子產(chǎn)生的減少，出現(xiàn)維生素B12缺乏，內(nèi)因子是維生素B12在遠(yuǎn)端小腸吸收的必需元素，同時(shí)，也因維生素B12與轉(zhuǎn)運(yùn)蛋白分離存在缺陷所致。這種缺乏常見(jiàn)于在胃切除術(shù)后2-4年或更久時(shí)，儲(chǔ)存的維生素耗盡。因此，胃切除術(shù)后的患者影密切隨訪，以避免鐵及維生素B12缺乏及貧血的發(fā)生。 　　　在過(guò)去的幾十年中，減肥手術(shù)已被建議作為肥胖患者的一種有效治療手段。有不同的手術(shù)方法，包括胃繞道手術(shù)， 腹腔鏡垂直束帶胃成形術(shù)，膽胰分流術(shù)，膽胰及十二指腸球部開(kāi)關(guān)分流術(shù)[41]。所有這些手術(shù)方式，都可以引起長(zhǎng)期的后遺癥，包括鐵， 維生素B12和葉酸不足[41,42]。 鐵缺失和貧血可以對(duì)生活質(zhì)量產(chǎn)生強(qiáng)烈的影響，特別是那些占減肥手術(shù)最主要部分的處于育齡期的婦女。在術(shù)后幾個(gè)月至幾年的隨訪中，大多數(shù)研究報(bào)告表明會(huì)出現(xiàn)鐵缺失，概率為6％至50％ [43-45]。在胃繞道手術(shù)1-9年后，可能會(huì)出現(xiàn)維生素B12缺乏，其患病率據(jù)估計(jì)達(dá)到12％-33％[42]。 　　　減肥手術(shù)后發(fā)生鐵缺失的大部分病例非常相似，胃酸分泌的減少和十二指腸礦置。在胃繞道手術(shù)，患者胃近端袋胃酸的分泌和產(chǎn)生減少，此外，十二指腸礦置影響了消化道連續(xù)性。胃袋成形術(shù)，保持胃竇和十二指腸的

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