Xiaojun Guan, Jiwei Liu, Jun Ma, Xiuru Shao

Harbin Institute of Hematology and Oncology, Harbin First hospital

Objective:To summerize endoscopic characteristics of digestive infiltration affected by leukemic cells with digestive tract bleeding. Method: We retrospected and analyzed 3224 first-visited and hospitalized leukemia patients from May, 2000 to October, 2010. Among them, there were 59 patients with complain of digestive tract bleeding (19 cases of acute digestive tract bleeding as Acute Bleeding Group; and 40 cases of chronic digestive tract bleeding as Chronic Bleeding Group). All 59 patients with digestive tract bleeding (DTB) were immediately examined by gatropic or enteroscopic apparatus after hospitalization, and biopsy was performed for histopathology, together followed some leukemia measurements such as clinical hematology, molecular biology and cytogenetics. Result: The incidence rate of first-visited leukemia patients with DTB was 1.83% (59/3224). In acute bleeding group,13 cases were acute lower DTB(13/3224, 12 for acute leukemia, 1 for lymphoma) with the incidence rate as 0.40%; the other 6 cases were acute upper DTB (6/3224, 5 cases for AML,1 for lymphorma) with the incidence rate as 0.19%.There were 40 patients(1.24%)for chronic DTB(chronic bleeding group).Among them, 14 cases were lower DTB(9 for acute leukemia, 2 for chronic leukemia and NHL for 3) with the incidence rate of 0.43%(26/3224).Another 16 cases were chronic upper DTB (15 for acute leukemia, 2 for chronic leukemia and NHL for 4) with the rate of 0.80%.Endoscopic observations showed very different features. Conclusion:this study showed that such leukemia patients with digestive tract bleeding as an initial symptom were not rare. Between the 2 groups, the incidence rate of acute leukemia was obviously higher than that of chronic leukemia (45/14) with u=2.11, (P<0.01); especially the incidence rate of APL was markedly higher than that of other acute leukemia (33/45).In acute bleeding group, acute lower DTB was higher than acute upper DTB (13/6). Gastroscopic observations showed that most lesions appeared in gastric antrum and body with ulcerative bleeding on the surface; often seen non-uniform protrusions on the edge of it, thickened wall with stiffness, easy to bleeding. The enteroscopic features of intestinal infiltration affected by leukemic cells from patients with acute lower DTB showed that intestinal infiltrations involved wide-ranging with much bleeding, and presenting polymorphous. It was showed under scope that multiple patchy protrusions surrounded with multiple superficial ulcers or ulcerative bleeding; and deeper ulcer extended to blood vessels.

Key Words: leukemic cells