異型リンパ球のアプローチ

異型リンパ球数が少なく症状がないときは経過観察でよい場合が多いが、精査、診断が必要な場合のアプローチを示す。
[ID0601]1：異形リンパ球がみられる疾患
[ID0606]2：伝染性単核球症様の所見を呈することのある病態
出典
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1: Proportion positive for Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, Toxoplasma, and human immunodeficiency virus types 1 and 2 in heterophile-negative patients with an absolute lymphocytosis or an instrument-generated atypical lymphocyte flag.
著者: Y F Tsaparas, M L Brigden, R Mathias, E Thomas, J Raboud, P W Doyle
雑誌名: Arch Pathol Lab Med. 2000 Sep;124(9):1324-30. doi: 10.1043/0003-9985(2000)124<1324:PPFEBV>2.0.CO;2.
Abstract/Text: OBJECTIVES: To determine the proportion of patients with evidence of an acute infection due to Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), Toxoplasma, or human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2) in heterophile-negative patients with an absolute lymphocytosis or an instrument-generated atypical lymphocyte flag, and to develop a cost-effective testing algorithm for managing such heterophile-negative patients.
DESIGN: We conducted a prospective investigation of 70 selected outpatients who tested negative for heterophile antibody in association with an absolute lymphocytosis or instrument-generated atypical lymphocyte flag. The control population consisted of 50 patients who were heterophile negative and had a normal absolute lymphocyte count and no instrument-generated atypical lymphocyte flag.
SETTING: A large outpatient laboratory system.
INTERVENTION: Viral serology for HHV-6 was performed by immunofluorescence, and all other serologies were performed by enzyme-linked immunoassay. All testing was for immunoglobulin (Ig) M antibodies, except in the case of HIV.
RESULTS: The proportion of study patients positive for EBV was 40% (28/70); for CMV, 39% (27/70); for HHV-6, 25% (16/65); for Toxoplasma, 3% (2/70); and for HIV, 0% (0/70). All 50 control patients were negative for EBV IgM antibodies. When patients with more than 1 positive viral test were excluded from analysis, positivity was 20% (9/45) for EBV, 22% (10/45) for CMV, 9% (4/45) for HHV-6, and 2% (1/45) for Toxoplasma. Utilizing hypothesis-generating logistic regression models, Downey type II atypical lymphocytes were significantly associated with EBV positivity (P =.006), while Downey type III lymphocytes were significantly associated with HHV-6 positivity (P =.016), and there was a trend for the association of Downey type I lymphocytes with CMV positivity (P =.097).
CONCLUSIONS: A positive viral serology was identified in 70% of study patients. Multiple positive serologies complicate establishing a definitive diagnosis. Potential cost savings may be associated with the use of an appropriate testing algorithm.
Arch Pathol Lab Med. 2000 Sep;124(9):1324-30. doi: 10.1043/0003-9985(2...

異型リンパ球がみられる疾患

異型リンパ球は多くの病態でみられるが、ウイルス感染による場合が最も多く、その他の感染症やアレルギー反応でもみられる。
出典
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1: 著者提供

異型リンパ球の判定基準

日本臨床衛生技師会の勧告に基づく異型リンパ球の判定基準

異型リンパ球と異常リンパ球（リンパ系腫瘍）の特徴

“異型リンパ球＝腫瘍細胞”ではないが、異常リンパ球（リンパ系腫瘍）との鑑別が困難な場合もある。
出典
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1: 著者提供

伝染性単核球症でみられる異型リンパ球

大型で（赤血球の2倍以上）、細胞質が好塩基性で、核網が粗造～繊細で多彩な形態のリンパ球が増加している。

慢性リンパ性白血病

形態が均一で、やや大型で核/細胞質比（N/C比）が大きく、核に凝集したクロマチンを持つ成熟したリンパ球の増加を認める。異型リンパ球ではなく、異常リンパ球（リンパ系腫瘍）である。

伝染性単核球症様の所見を呈することのある病態（単核球症類似疾患）

EBウイルスによる単核球症を伝染性単核球症とする。それ以外の原因によるものを単核球症類似疾患とし多岐にわたる原因でみられる。
出典
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1: Diagnostic evaluation of mononucleosis-like illnesses.
著者: Christopher Hurt, Dominick Tammaro
雑誌名: Am J Med. 2007 Oct;120(10):911.e1-8. doi: 10.1016/j.amjmed.2006.12.011.
Abstract/Text: Clinicians face a diagnostic challenge when a patient with the classic fever, pharyngitis, and lymphadenopathy triad of infectious mononucleosis has a negative "spot" heterophile antibody test. This screening test, although commonly considered sensitive for the presence of Epstein-Barr virus (EBV) infection, may be negative early after infection. A growing number of pathogens have been reported to cause heterophile-negative mononucleosis-like illnesses, including cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), human immunodeficiency virus (HIV), adenovirus, herpes simplex virus (HSV), Streptococcus pyogenes, and Toxoplasma gondii. Other infectious and noninfectious disorders also may present in ways that mimic mononucleosis, but fail to generate EBV's archetypal triad of clinical findings. A systematic approach to the diagnosis of mononucleosis-like illnesses ensures that conditions warranting specific therapy are distinguished from others requiring only supportive care.
Am J Med. 2007 Oct;120(10):911.e1-8. doi: 10.1016/j.amjmed.2006.12.011...

異型リンパ球のアプローチ

異型リンパ球数が少なく症状がないときは経過観察でよい場合が多いが、精査、診断が必要な場合のアプローチを示す。
[ID0601]1：異形リンパ球がみられる疾患
[ID0606]2：伝染性単核球症様の所見を呈することのある病態
出典
imgimg
1: Proportion positive for Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, Toxoplasma, and human immunodeficiency virus types 1 and 2 in heterophile-negative patients with an absolute lymphocytosis or an instrument-generated atypical lymphocyte flag.
著者: Y F Tsaparas, M L Brigden, R Mathias, E Thomas, J Raboud, P W Doyle
雑誌名: Arch Pathol Lab Med. 2000 Sep;124(9):1324-30. doi: 10.1043/0003-9985(2000)124<1324:PPFEBV>2.0.CO;2.
Abstract/Text: OBJECTIVES: To determine the proportion of patients with evidence of an acute infection due to Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 6 (HHV-6), Toxoplasma, or human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2) in heterophile-negative patients with an absolute lymphocytosis or an instrument-generated atypical lymphocyte flag, and to develop a cost-effective testing algorithm for managing such heterophile-negative patients.
DESIGN: We conducted a prospective investigation of 70 selected outpatients who tested negative for heterophile antibody in association with an absolute lymphocytosis or instrument-generated atypical lymphocyte flag. The control population consisted of 50 patients who were heterophile negative and had a normal absolute lymphocyte count and no instrument-generated atypical lymphocyte flag.
SETTING: A large outpatient laboratory system.
INTERVENTION: Viral serology for HHV-6 was performed by immunofluorescence, and all other serologies were performed by enzyme-linked immunoassay. All testing was for immunoglobulin (Ig) M antibodies, except in the case of HIV.
RESULTS: The proportion of study patients positive for EBV was 40% (28/70); for CMV, 39% (27/70); for HHV-6, 25% (16/65); for Toxoplasma, 3% (2/70); and for HIV, 0% (0/70). All 50 control patients were negative for EBV IgM antibodies. When patients with more than 1 positive viral test were excluded from analysis, positivity was 20% (9/45) for EBV, 22% (10/45) for CMV, 9% (4/45) for HHV-6, and 2% (1/45) for Toxoplasma. Utilizing hypothesis-generating logistic regression models, Downey type II atypical lymphocytes were significantly associated with EBV positivity (P =.006), while Downey type III lymphocytes were significantly associated with HHV-6 positivity (P =.016), and there was a trend for the association of Downey type I lymphocytes with CMV positivity (P =.097).
CONCLUSIONS: A positive viral serology was identified in 70% of study patients. Multiple positive serologies complicate establishing a definitive diagnosis. Potential cost savings may be associated with the use of an appropriate testing algorithm.
Arch Pathol Lab Med. 2000 Sep;124(9):1324-30. doi: 10.1043/0003-9985(2...

異型リンパ球がみられる疾患

異型リンパ球は多くの病態でみられるが、ウイルス感染による場合が最も多く、その他の感染症やアレルギー反応でもみられる。
出典
img
1: 著者提供