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Myelotoxic agranulocytosis occurs as a result of suppression of the growth of granulocytes in the bone marrow, including stem cells. In this regard, there is a decrease in the blood not only of granulocytes, but also of platelets, reticulocytes and lymphocytes. Myelotoxic agranulocytosis can develop as a result of exposure to ionizing radiation, chemical compounds with cytostatic properties (anticancer drugs, benzene, and others), waste products of a fungus such as Fusarium, which multiplies in overwintered grain.
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A special place is occupied by agranulocytosis in systemic lesions of chloroquine apparatus - leukemia, hypoplastic anemia, as well as in metastases in the bone marrow of cancer and sarcoma.
Immune agranulocytosis develops as a result of accelerated death of granulocytes under the influence of antileukocyte antibodies; stem cells are not chloroquine. Antileukocyte antibodies are formed under the influence of medications that can play the role of haptens. With the repeated administration of such a medication, agglutination of leukocytes appears.
The development of immune agranulocytosis depends little on the dose of the drug, the most important role in its occurrence is played by the unusual sensitivity of the organism. On the contrary, in myelotoxic agranulocytosis, the decisive role belongs to the magnitude of the damaging effect. Among the drugs that cause immune agranulocytosis, the main place belongs to amidopyrine. In addition, butadione, phenacetin, atophan, analgin, diacarb, barbamil, sulfonamides, PASK, tubazid, ethoxide, streptomycin, pipolfen and some other drugs can cause immune agranulocytosis. Long-term use of the drug hapten can cause the destruction of not only mature granulocytes, but also myelocytes and promyelocytes. The development of autoimmune agranulocytosis, more often leukopenia, is observed in collagenosis (especially disseminated lupus erythematosus, rheumatoid arthritis), as well as in some infections.
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Pathological signs of agranulocytosis are necrotic-ulcerative changes, most often found in the oral cavity and pharynx. The tonsils are enlarged, loose, gray-dirty, with fibrinous overlays and ulceration. In the area of the soft and hard palate, foci of necrosis are found, sometimes with perforation of the soft palate.
Necrotic changes are detected in the skin, at injection sites, in the perineum, around the anus. Foci of necrosis are described in the conjunctival sac, in the mucous membrane of the larynx, esophagus and stomach. With the development of necrosis in the mucous membrane of the small or large intestine, including the appendix, intestinal bleeding and perforation are observed.
Necrotic ulcers can be in the wall of the bladder, in the genitals, especially in the vaginal wall, as well as in liver tissue and other chloroquine. Microscopic examination shows that there are no neutrophilic leukocytes in the areas of necrosis. The demarcation band around the necrosis is not detected; near the sites of necrosis, lympho-histiocytic and plasma cell accumulations can be seen.
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In this case, fibrinous overlays are located on the pleura. In the area of pneumonia, areas of tissue decay (gangrene) can be detected. Microscopically, desquamated epithelial cells, bacteria, yeast cells and their mycelium are visible in the lumens of the alveoli.
Lymph nodes are usually not enlarged. With necrotic changes in the oral cavity, it mayobserved a slight increase in the cervical and submandibular lymph nodes. Their microscopic structure is relatively preserved.
A large number of plasma cells are detected in the cortical layer and especially in the region of the cords. Proliferation and swelling of reticuloendothelial cells in the sinuses is sharply expressed.
The spleen is often not changed. The tissue of the spleen is of a soft consistency; the section shows a pink-gray pulp with a large scraping. At microscopic examination, attention is drawn to a uniform decrease in the number of cells of the red pulp of the spleen.
Bone marrow of flat bones is macroscopically more frequent than usual, somewhat dry, but there may be various foci of hemorrhage - from small to extensive; in the lower and middle third of the tubular bones, the fatty bone marrow. Microscopically, small foci of resorption of bone trabeculae with the formation of small lacunae are revealed. In areas of bone resorption, osteoblast proliferation can be observed.
The ratio of adipose and hematopoietic tissue is different. More often, there is a decrease in the number of hematopoietic cells and an increase in the number of fat cells in the bone marrow. In the cellular composition, attention is drawn to a sharp decrease in the number of young, stab and segmented granulocytes. There may be some predominance of young forms of granulocytes.
As a rule, megakaryocytes and red cells are preserved. In the most severe course of agranulocytosis, the picture of the bone marrow is the same as in hypoplastic anemia.