【小编翻译】外周血中温度相关的冷球蛋白结晶形态转化

这是北京协和医院检验科撰写，发布在《BLOOD》杂志上的一篇案例报道，小编将进行翻译。和WHO蓝皮书的翻译系列类似，原案例报道的英语原文在前（并有苹果绿底色），中文翻译在后。

原文截图：

A 66-year-old man presented with a 5-year history of lower-limb livedo reticularis.

【翻译】患者男，66岁，下肢网状青斑病史5年。

Complete blood count demonstrated: hemoglobin, 108 g/L; leukocytes, 9.46×10e9/L; and platelets, 393×10e9/L; increased large unstained cells were noted on automated differential.

【翻译】全细胞计数：血红蛋白108g/L，白细胞9.46×10e9/L，血小板393×10e9/L；自动化分类显示未染色大细胞增多。

His plasma showed gel-like precipitation (panel A).

【翻译】患者的血浆中有凝胶样的沉淀物（图A）。

His blood smear showed visible fine-grained agglutinates compared with control (panel B).

【翻译】与正常对照相比，该患者的血涂片中有明显的颗粒样凝集物。

Wright-Giemsa staining (panels C, D, F, G) demonstrated multiple extracellular cylindrical crystals (panel C; original magnification ×1000) that partially resolved with warming to 37°C for 30 minutes (panel D; original magnification ×1000).

【翻译】瑞姬氏染色（图C, D, F, G）证实存在许多细胞外的圆柱状晶体（图C，×1000），37℃温浴30分钟可部分消除该现象（图D，×1000）。

Variable sizes of cylindrical and irregular crystals were observed by phase-contrast microscopy after lysing red blood cells (RBCs) (panel E; original magnification ×400).

【翻译】将红细胞溶解后用相差显微镜观察，可见大量圆柱形和不规则的晶体（图E，×400）。

However, when the patient's sample was delivered at 37°C and tested immediately, only scattered amorphous particles were observed (panel F; original magnification ×1000), which aggregated at room temperature after 30 minutes and induced RBC morphologic changes mimicking schistocytes and helmet cells (panel G; original magnification ×1000) without actual hemolysis (indirect bilirubin, 3.3 mmol/L; lactate dehydrogenase, 382 U/L).

【翻译】不过，当患者的血样在37℃的条件下运送并立即检测，只能观察到散在的不定型成分；（这些成分）在室温下放置30分钟后出现聚集，并诱发红细胞形态改变，似裂红细胞和盔形红细胞（图G，×1000），但并未发生溶血（间接胆红素3.3 mmol/L，乳酸脱氢酶382U/L）

Cryoglobulin testing showed monoclonal immunoglobulin G λ (13091.5 mg/L).

【翻译】冷球蛋白测定显示存在单克隆的免疫球蛋白G λ轻链（13091.5 mg/L）。

Bone marrow examination revealed 15.5% myeloma cells, and multiple myeloma with type 1 cryoglobulinemia was diagnosed.

【翻译】骨髓检查发现有15.5%的骨髓瘤细胞，诊断为多发性骨髓瘤伴1型冷球蛋白血症。

Cryoglobulin crystallization with clear morphology is a rare phenomenon with different structures.

【翻译】结构不一的冷球蛋白结晶具有清晰的形态是极为罕见的现象。

This case illustrates how cryoglobulin transforms from cylindrical to amorphous in shape, and induces RBC morphologic changes on a peripheral smear.

【翻译】本案例说明了冷球蛋白是如何从圆柱体样转变为不定型样，并诱发外周血红细胞形态学改变的。