1. No category

From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
1951 6: 261-269
Erythroleukemia
E. K. BLACKBURN and L. G. LAJTHA
Updated information and services can be found at:
http://www.bloodjournal.org/content/6/3/261.full.html
Articles on similar topics can be found in the following Blood collections
Information about reproducing this article in parts or in its entirety may be found online at:
http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests
Information about ordering reprints may be found online at:
http://www.bloodjournal.org/site/misc/rights.xhtml#reprints
Information about subscriptions and ASH membership may be found online at:
http://www.bloodjournal.org/site/subscriptions/index.xhtml
Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of
Hematology, 2021 L St, NW, Suite 900, Washington DC 20036.
Copyright 2011 by The American Society of Hematology; all rights reserved.
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
.irythro1eukemia
By
IT
E.
Ic.
IS THE
PURPOSE
vestigations
culture
of this
suggested
was
these
prepared
cells.
It
the
papet-
ti-tie
of the
f-hat
nature
of the
A l)atterti
been
maker,
6, 1948,
treated
for
returning
to
on
There
iii
in
the
was
‘as
anol
was
in
the
but
tuo other
the
‘ho1e
tected
showed
mouth
and
lymph
the
ahdonueni
iii
no
were
the
below
costa!
on
rectal
or
No
atid
anal
l)ast
or
of
helpfu!
enhan’ged.
No
anal
mornings.
jaw
had
the
been
‘as
in
spent
malaria
icten’ic.
anid
node
in-
froni
soft
The
sl)lecni
abniornial
ten1pera-
There
.
enlarged
‘aS
Apart
limbs
his
22 P#{176}’’
Iu)i it
niornial.
The
exertional
of
had
truly
rat e
other
of
had
After
in the
angle
have
he
doctor.
history.
riot
ory
owti
sweating.
Three
years
family
lyniph
aIpeared
was
his
right
Sheffield,
l)revmously
energy
to
but
rat
examiriationi.
1)urPurlt
behavior
Iuifirman’v,
sputum
the
t hought
torisillar
niargini.
of
lack
was
rcspi
right
1113(1 lungs
left
in-
marrow’
proved
weeks
by
of
1013(1 sallow,
. ,
Royal
Five
shivering
infectious.
he
significantly
heart
the
ahniornialitv.
pale
The
.
of
the
to
below
significant
flu n
throat
nodes
1 itich
other
96
rate
precorolium,
tending
nto
ap)eareol
and
has
r’nucopun’ulenit
soreness
where
,
rate
methoc!
sulfonaniides
a little
anid
East
routine
A hone
matui-at-ion
conil)lainied
coml)lained
of respiratory
Far
l)atmenit
I ()0 F . , pulse
chianuges
he
noticed,
Later
he
history
There
the
anid
He expectorate(I
Middle
hepatitis.
tiune,
in which
HISTORY
penicillin
weeks’
tirinitus
On aolmission
t ure
two
palpitationis.
swallowing.
W1i5 Ito previous
t-lue Arms’
fective
with
M.D.
precursors.
a culture
X., aged 27 years,
was
aolnimtted
the care of Dr. A. W. D. Leishman.
tonsillitis
work
d’spnoea
lOud
Slight
bilateral
present
i\Ii-.
under
LAJTHA,
disease.
CASE
out July
cell
the
such
G.
on a case
ted
to defermine
suggested
L.
AND
to repot-t
a disorder
in ot-der
is later
in establishing
F.ILF.P.S.
M.D.,
BLACKBURN,
were
aniol
systolic
bruits
\‘It5
phYsical
oven’
l)alpable,
signs
111111 central
no
ten(ler,
cx-
were
uiervous
de-
system
oietected.
Investigations
Pci’iphei’al
CI.
Blood
1.07,
1,1521cu.unni.,
chrouu’iic.
No
malarial
1)ert).
in(li
From
Depart
It
to
A.
of
Pituev
arid
CII5C
for
in
Clinical
to
case
l)erniission
ccitt
both
of
Pat
react
thick
ioni
icr’
our
quote
for
macrocytosis
red
showed
cells
thin
Serum
ive.
from
Royal
Radcliffe
films.
1 .92
\I/cu.nuru.,
M.C.i1.C.
ant
his
Plasma
30.5
criticisni.
261
(Lee
and
0.2
anid
Dr.
in one
White)
pen’
hi rombi
ni corit
Sheffield,
mye-
showed
nig
ruornio1IILt tern.
(Lem-
hour.
five
100
Bleeding
mi
ml.
nut
es.
1)irect-
cut
(1 -st age,
England
1011(1 the
Eniglarid.
A. W. D.
and
cells
tiuclear
mg.
Oxford,
Dr.
red
al)llcari
77,000,/cu,mm.
135 mm.
prot
euucoun’agemerit
notes
Platelets
Iuifirmau’v,
tl)
Thie
and
a megaloid
bihir’uhlini
Inifirmam’v,
mnudebtcolness
conist
R.B.C.
,
224/cu.nnm.
towards
arid
the
the
)
(Pitt
MCII.
rc(1 cells
niegat
hematology,
liologv,
and
to
Guii.
lOOcu.,
32/cu.mm.
, Pron’iyelocvtes
32/cu.nim.
, N .
, N . llolynnorphs
I 696/cumin.
, Lymphocytes
niortnal.
acknowledge
notes,
(5.8
M.C.\’.
1 po cenit.
E.S.R.
(Westergren)
er mi nut es. Cl ott i nig time
Bergh
1)epartnuenit
is a pleasure
the
helpful
the
nicnt
dent
per’
nucleated
(Rumpcl-Leedc)
vati
rect
Some
found
arid
41
Hh.
Mycloblasts
cells
160/cu.nim.
less than
t hree-quart
fragility
.
19 percenit,
seen.
parasites
Capillary
and
1)
64/cu.mm.,
Nucleated
poikilocyt
osms, ten(Iing
spherocytes
Reticulocytes
(Ivy)
two
time
-
Monocvtes
osis
arid
ariisocyt
No
table
P.C.V.
,
hocvtes
slight
(see
8.0/2,
W.B .C . 3,200/cu.mni.,
64/cu.nuitii.
, N . l)alid
cent-
iI
MCD.
help.
Leishman
for
We also
H. U. Macfarlane
thank
for
his
access
Dr.
most-
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
262
ERYTH
Quick)
ni(Irnnal.
101)
1(X) nil
.
Pla.snua
Gnn.
0.3-8
nil . , Seruni
CIL1CiUIfl
10.0 fig.
Serumu alkaline
l)hiosl)huat ase
TABLE
1.-Peripheral
!
Date
Hb
6/48
41
7/10-48
W:,3
32’
32
64-
s.
Cou,’se
Disease
mm.
mm.
Bare
:
‘.
1601,6961,152
tug.
phiosphat
of the
!
:
5.7 mug.
acid
4.2
64-
(itI:
cu.
224 1%
-
76 266
266
9881,444,
760
-
+
22$’
+
+
+
2%
2%
7.02.48
50
7/26/48
48
+
6.7
2.078,0002,000
480
320
2,7201,200
-
++1%
1,2804,160
-
1%
1%
7/28/48
7/29/4847
1%
6.7
7/30/48
44
6.2
2.10!
1%
1%
7/30/487210.1
3/48
4/48
71
!
1%
10.0
-
8/10/48
8/16/48
8/ 23/48
9.53.20!
50
7.7
7.1
2.465,000
5.5
1 . 705, 000 1 , 025
39
8/26/48
176 836
4,400
68
8/12/48’SS
300
300
5.6
60
9.35
2.90!9,600!
56
8.75
2.89-6,900
345
9/ /4$*
()/29/4$*
76
72
11 . 85
11.25
3 . 46 3, 480
69
396
10/ 6/48*
10/12/48*,
100
15.69
4.75!2,900
15.3
4.50-3,600!
10/
100
15.69
4.803,200!
33
4.6
9/48*
9/16/48*,
98
19/48*
11/ 2/48
11/5/48
7210.1
11/29/48
55
12/14/4838
12/15/48
12/16/48
*
From
Gut iuiaii
Mug.
60
64
;cr
( ni. per
Dr.
unit
2.69!4,400
660.1,012
+
-
1,1501,5001,250
25
125 1 , 575 1 , 375
50
450
675
-
-
432
-
-
-
-
396
+
-
1%
250
+
-
-
58
-
-
180
624
364
+
+
2,1121,584
1,566-
207
-
1%
-
-
626
-
783
145’
432
216
2,240,
864
96!
676,
52
520
---+
5.6
-
8.5
9.0i__+
+ +
132
+
108
-
-
260
-
-
-
++
+
+
-
+
!
+
+
+
-!
+
-
+
-
-
---
-
345
220!
362,700
104
-
+
-
1381,8634,347
35 1 , 4921 , 288
88
-
36
-
3361,0562,0164,5121,200
-
-
Pinuc”s
S.
-
200
348
1.65-2,600,
8.1
-#{149}
--
-‘-
--
-
-
----
-
-
findings.
Forn1aldehi’(le
ml. Serum
1()0 tiul . Tot hI
100
704
!]
7.2
11/4/4850
1,012
H
40
9/
-
1%
2%
1.5%
7.7
7/23/48
8/
yes
-
7/22/48
8/
per
I15C
teat:
-
-
8.5
2.753,800!
8.8!2.951
8.12.60
7.7
2.57
7/21/4855
uric
phosphorus
Sen’unn
a(’i(l
-!-
8.2--
60
63
58
55
7/16/48
7/17/48
7/19/48
unit
the
\)),iI
mm.
I . Serum
iniorganiic
Thl’olI(/hout
mm.
1.923,200
100 nut. (I’jcldahii
6.5--
7/12/48-58
-
I”indings
!bt5t
mm.
5.8
46
7/14/48
!
per
EMI.-
jer
101) nuth . Scrutnu
6 1’limig-Arnist
ronig
Blood
Gm.
(‘
7/
fibriniogeni
ROLEUK
total
serum
sI al)le
Iil)oi(1
alh)uiiuini
acid
fatty
l)hosPhiat
acids
3.6
Gn’i.
lose
2 Gut
nuint
units.
Serum
330 mg. per 1()0 ml. Total
serum
lI
100 uiil . Tot :il seruni
globulin
iron
Proteinis
2()0
6.8
3.2 Cmii. per
3
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
E.
nil. Paul-Butineil
100
K.
test
BLACKBURN
niegative.
AND
L.
blood
Repeated
G.
263
LAJTHA
cultures
sterile.
Wassermann
reactiotu
negative.
Fractional
t
‘rine
‘l’est .11cc!. Nornual
Normal
. No
Bence-Jones
.
Fecal
urohulinogen.
mg.
urobilinogenu.
340
X-ray
curve.
Twenty-four
hourly
Chest-
examinations.
Free
HCI
present
No
.
blood
detected.
prot ci n.
specinuen
(includinig
bony
of feces
thorax),
(vet
weight
pelvis,
97 Gm.)
feniora,
conitainied
skull,
no
abnior-
mahitv.
Sternal
norrow.
Differenutial
count
of 2()0
cells
(per
cenit
)
Myeloblasts
4 ‘5
Lymphocytes
1 .0
Paramyeloblasts
3 .5
Plasmocytes
2.0
6.5
Reticulum
cells
Cells in mitosis
0.5
Pronuyelocvtes
N.
myelocytes
11.5
N.
hand
N.
polymorphs
cells
Eosinuophils
2.5
Pronormoblasts
1 .5
Basoph.
2.5
Polychr.
normoblast-s
normoblasts
Orthochr.
Leuko-en-ythrogenuetic
in
Clinical
Course
This
ratio
the nucleated
changes
is
summarized
admission
Bone
to
Marrow
One
roufine
in
table
of Dr.
2. Repeated
A. Piney,
proved
in
of us (L. G. L.)
marrow’
cultures.
Osgood
of t-he marrow’
4 culture
bottles,
has pci-formed
From
these
were
opened
in table
*
Blast
monuoc’toid
blood
transfusions,
empirical
avail,
the
tn-e some
seen.
including
treatment
patienit
c-ounfed
Brow’nlee
with
dying
six
megaloid
exsanguino-
iron,
liver,
months
folic
after
his
technic#{176}was
contained
contents
see
70 peu cent
medium,
acid
per
hours’
smears
used.
A homogenous
f-able
3) was
distributed
human
serum
not-mal
suspenint-o
+
30 per
w’hile the other
2 bottles
contained
3 ml. of the above
culture
medium.
incubation
respectively,
the bottles
centrifuged.
on 3 successive
past three
years
more
than
120
possible
to recognize
a standarc!
Marked
differences
from
normal
are
and in the vauious
forms
of leukemia.
the maturaf
ion u-ate and path
of this
suspension,”
as a culture
mg. of folic
and
forty-eightthe
over the
it has been
marrows.
anemia
investigate
(“initial
2 of which
and
were
and
cells
cent
Ringer
solution
an additional
0.005
After
t-w-enty-four
cells
increase(l.
There
seen. No parasites
arid
no
-
TTitro.
rate
of maturation
in normal
always
found
in megaloblastic
Thus
we were
stimulated
to
sion
of
normoblasts
hospital.
Culture
marrow.
A modified
Cellularity
red cells. No megaloblasts
t-ransfusionu
unider the care
acid,
urethane
and
penicillin
first
0.42.
=
2.5
7.5
37.5
16.5
Smeau-s
from
each
w’eu’e made.
bottle.
The
3.
One
results
thousand
are
shown
-
cells
slightly
characteristics
more
differentiated
in
their
nuclear
thami
structure
primitive
anid
mycloblasts
shape.
which
have
some
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
264
ERYTHROLEUKEMIA
TABLE
Date
‘:
Semeiotogy
7/10/48
Temp.
-
7/i2/48
7/i4/48
2.-Clinical
iOt
as
state
Afebrite.
F.
PuLse
on
86
admission
Subjective
Spienomegaty
!
per
mm.
(see
text).
Clinical
(3
?
6.5
Biood
1,080
Transfusions
niit.of
given.
irnprovenient.
increasing,
Course
in.
heiow
Drug
packed
No
Treatment
ceits1
reaction.
!
8.2
-
i
8.5
-
Anatiemin
niiargin).
iiii.
commenced,
then
2 nil.
4
daily
in-
trauiuscuiarly.
7/i5/48
Again
7/22/48
Still
febriie.
low
interrluittent
pyrexia.
7.7
Foiic
acid
itig.
7/30/48
Marked
clinical
deterioration.
-
6.2
i,080
cells
ml.
of
given.
packed
‘
Subjective
verted
costal
improvement.
Tentiperature
Spleen
to normal.
hours,
3
every
units
intramuscularly.
re’
21 inches
below
margin.
8/10/48
9.5
1
ml.
Ferrivenin
venously.
8/ii/48
niiouth.
commenced,
60,000
tion.
7/31/48
by
Penicillin
reac-
No
iOO
cornniienced,
daiiy,
Tonsillar
lyniph
node
unchanged.
intra-
No
Urethane
reaction.
(mm.
1
t.d.s.
commenced.
8/12/48
Nausea,
hint
8/17/48
Clinical
deterioration.
8/22/48
Further
no
vomiting.
7.7
Still
deterioration.
below
costal
7.1
febrile.
Spleen
11
Penicillin
2
inches
niargin.
not.
5
5.5
borne.
5.6
No
and
stopped.
9/
7/48
,
Admitted
to
Plaistow,
tinder
St.
care
9/ 9,/48
Mary’s
of
Dr.
Hospital,
A.
1
have
ferrous
Gm.
t.d.s.
b.d.
All
-
Piney.
9.35
Intermittent
ment
replacetransfusions
2,700
comnienced:
ml.
given,
of
whole
1,080
blood
rut,
re-
moved.
9/15/48
-
Slow
rise
540 ml.
in temperature.
given.
9/16/48
Subjective
improvement.
8.75
of whole
blood
drug
Ferrivenin
ure-
Continue
thane
20 mg
intra-
alternate
commenced.
Anahemin
-
reaction.
ml.
Ferrivenin
venously,
on
days
Discharged
intra-
Ferrivenin
venously.
8/23/48
8/27/48
stopped.
(an.
t.d.s.
To
sulphate
and
therapy
folic acid
stopped.
6
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
E.
K.
BLACKBURN
AND
G.
:
Semeiology
?,
9/18/48
-‘
Blood
Transfusions
2,700
ml.
blood
nil.
10/ 2/48
750
of
ml.
nit.
ml.
of
10/19/48
Discharged
11/
Readmitted
2/48
of
whole
Then
of
whole
pale.
mm.
Small
shin
at titesite
Liver
and
costal
margin.
enlarged
of
and
2,700
cells
given.
Royal
of
3,780
blood
2,160
blood
packed
Infirmary,
anorexia,
Temp.
Pulse
101 F.
healing
ulcer
on
of a previous
spleen
each
No
lymph
None
nausea.
126 per
the
right
transfusion.
1
inches
below
tenderness.
bony
No
nodes.
11/ 3/48
1,080
cells
11/
whole
blood
15.69
to the
Insomnia,
Very
and
ml.
re-
2,700
15.69
homne.
Sheffield.
3,500
blood
Then
removed
improved.
whoje
removed.
given.
Subjectively
Drug
given,
nmioved.
10/ 6/48
265
LAJTHA
2.-Continued
TABLE
Date
L.
4/48
ml.
of
packed
given.
540 nil. of packed
cells
given.
11/
5/48
10.1
270 ml, of packed
cells
and 540 ml. of whole
blood
11/
6/48
Subjectively
signs
much
improved.
unchanged.
given.
Physical
Afebrile.
Discharged
home.
11/27/48
Readmitted
to
hospital
for
Pulse
120 per mm.
pyrexia. No purpura.
ness.
No
controlled
11/28/48
11/29/48
Nasal
plug
Discharged
12/14/48
Readmitted
Temp.
12/15/48
Low
by
node
not
nasal
enlargement.
palpable.
Epistaxis
tampons.
removed.
home.
8.1
to
102
just
No
lymph
and spleen
Liver
epistaxis.
intermittent
bone
tender-
Low
F.
hospital.
Pulse
Critically
88 per
mm.
ill.
5.6
Spleen
1620
cells
intermittent
pyrex’ia.
8.5
540 ml.
given.
12/18/48
Some
clinical
improvement.
Discharged
9.0
home.
12/23/48
Died
ml.
of
packed
given.
palpable.
in his
autopsy
sleep
was
at
not
home.
obtained.
Permission
for
of whole
blood
Treatment
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
266
ERY’rIIRoLEuKEMIA
Interpretation
The
o,f the
(‘tilt
maturation
might
ares.
rate
of the
be consideredl
even
flue
abnormall
ure
1).
dli(l
not- give
red
large
any
to
place
cell
precursors
dhuuestionable
numbeu-
rise
3.-Bone
was
Marrow
more
Hour
in normal
421)
Promvelocvtes
N. Myelocvtes
N. Band
Cells
N. Segniented
1’.osinophils
Lymphocytes
(No.
Forty-eight
Culture
422)
folic
acid
(No.
423)
4.5
5.5
5.0
3.5
5.0
5.5
(No.
5.0
4.5
IC.0
14.0
-
3.5
4.0
-
5.5
6.0
.
424)
-
6.5
2.5
serum
-
11.5
1.5
but
This
re-
Hour
______________________________
in normal
m1m1
serum
.
forms.
______________________________
Suspension
‘‘Parannveloblasts’’
(fig-
decreased,
mature
Twenty’four
Culture
Nlvclohla.sts.
It
maturation
Culture
initial
(No.
uu’as delayed.
any
normoblasts
the
in
marrow
there
basophilic
of
corresponding
TABLE
this
d)f
w’hef her
folic
acid
(No.
425)
2.0
0.5
2.0
0.5
3.5
3.0
23.0
26.5
10.0
9.5
10.5
2.0
12.0
2.0
2.5
2.0
1.5
1.0
2.0
2.5
2.5
3.0
Plasnuoctes
2.0
2.5
4.0
3.0
4.5
Reticulum
cells
Cells in Mitosis
0.5
1.0
1.0
2.5
2.0
2.5
2.0
1.5
0.5
0.5
0.5
Proniormoblasts
B11S01)huil
7.5
niorniobla,sts
Polvchromatic
nornioblasts
Orthochromatic
Free
20.5
7.5
8.0
11.0
3.0
8.0
-
nuclei/lOO
cells
-
No.
421
No.
422.
Frequent
.
No.
423.
No
424.
Most
No.
5”
425.
“nuegaloid”
:tll the
Neltrl\’
t-ruded
was
ca.ses.
flue culture
fairly
They
(figure
not
matut-ation
in the
nuclei
usual
cultures
rapidl
lysis
maintained
2).
seen.
31.0
5.0
5.0
13.0
18.0
20.0
10.0
22.0
24.0
deficiency
was
the
Some
present.
hasophil
“Para-
niormoblasts.
mitoses
seen.
The
fate
character
an
increased
high
Remarkably
in the serum,
high.
common
pyknotic
also
nuuclci.
marrow.
unusually
is the
their
Thet-e
l)Yknuotic
a not-mal
most-
was
in
nuclei.
st-ill
“Para-
fornis.
to any
which
megaloillasts.
cells
changes
pyknotmc
have
in
typical
“megaloid”
1)egenerative
unoniocytoid
due
No
Occasional
have
niormoblasts
tiuclei.
pvknotic
normal
to
patterns.
forms.
niormoblasts
mt imig
differenit
maturation
prodlucedi
nuclear
cells
the
of
(? extruded)
tarded
‘‘nuegaloid’’
Sonic Itt\’l)icItl
mitotic
‘ nire
differentiated.
No.
tiuvelolliast
5.0
28.0
-
eel! morphohup,
on
niyelohlasts’
mal
16.5
19.0
24.5
6.5
cells/l90 cells
Remarks
the
0.5
20.0
nornuoblasts
pyknuotic
Smear
free
2.0
37.5
-
since
proportion
These
ft-ce nuclei
nuclei
throughout
the
of
of
f-he serum
of free cx-
of extruded
proportion
ratio
escaped
in
period
smear
nor-
of
cells
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
E.
(degeneu-ated
red
(lying
cells
was
(‘3
1
cells)
not
Mr.).
K.
BL.’t(’Klil.ItN
in the
L.
The
o’ultui’es.
G.
267
LAJTiIA
effect
of
acid
folic
on
the
nucleated
marked.
L’Zyo.oxs.
RED
CELLS
.l,Oyasrs.
MARRY%’v
NOR,MAL
MARR)W
WUCLEAThD
V.
Mr.
ETI4R#{216}LWtIA
6O
AND
IN VITR,Q
R.gD
!IJUCLEAIED
CELLS
IN VTR.
Bosojktl
Normoblost’s
Pronormthla.sts.
RIychronmic
Morma#{243}Io3+s.
Orothrom
tormob{ist.
50
1#{176}
2O
La
I -U
Fir..
raphs
showing
t lie
mat
ur:tt
ion
rate
of
cell
red
pre(-ursors
-
FnG
2.-I/’t:
.
nu(’lcus
in
y-eight
fort
These
who
that
they
the
disappear
-eight
bout’
cult
cell
bout’
at-c
describe
the
suggest
nucleaifrom
in
cult
\Ir.
tire.
_N’s
Iti1h
(‘enter:
tuartois’.
1:
N tuclc:tr’
Eryt
shialll)ws
hiroblztst
free
arid
arid
pyknil)1
free
i(’
pvkniot
ic
miuclei
mi
tire.
obseu-vations
also
anism
\legaloicl
font
as the
matuuat
the
in
slower
main
ion
polychromat
with
ad’oot-dlance
mat
ut-at
cause
is tlist
ion
rate
of anemia
un’bedl
mc uionmol
those
of
these
in
these
qualitatively,
)lasts
(leaving
of Astaldi
cells
in
They
cases.
the
as
a
and
‘itn-o.
ict
nucleus
iculot’yt
Iolentin&
mccli-
fluis
also
in(licate
does
niot
e I )o’hmno 1),
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
268
ERYTIIROLEUKEMIA
continues
butsuits
lend
to) exist
some
unusually
eveti
u’hien
confirmation
high
resistance
andl
the
cytoplasm
statement,
this
to
sfttl)ility
J)ifferentiai
I)iajno.s’is.
rol)lastic
peripheral
fions as carcinomatosis,
anemia,
hemolytic
OldiOsis,
Leislimaniasis
disease
be
and
result
of the
1)100(1
(i\’sd’rtLsia.
There
500fl
mat’t’ow
(Copelli,2
case here
apparent.
eultuu-e
and
the
from
that
this
syphilis,
appearance
dhisease
dyscrasias
a leukoerythclinical
toxic
All
Leitner
et al.6)
is neithetone
is
of
the
and myeloblastic
of etythremic
the
and!
al)normahities
erythu-emic
leukemia
myelosis
of the
could
as a primary
I’
I)etween
lip-
course
dhiseases
mai-row
characterized
gradations
condiaplastic
tuberculosis,
uu’as to 1)e u-egarded
which
leukopoiesis.
Guglielmo,3
deseril)edl
myeloma,
with
varying
disease,
hepatitis.
From
the clinical
of investigation,
the majority
of these
of such
erythro-
associatedi
in such
Hodgkin’s
infed-tive
metho(ls
was
is a group
in both
myelosclerosis,
an(l
rean
SulIAaY
anemia
Auu unresponsive
anemia,
It
AND
Our
showing
cultuu-es.
1)100(1 picfuu-e
may be seen
leukemia
in early phase,
routine
excluoled.
the
in
l)Isd’ussIoN
is fully
differentiatedl.
the extrudled
nuclei
myelosis
may
uuoi- one
occur.
The
of
acute
leukemia.
I Iei1Ie\’et’
Several
nor
a
transita)nal
chulin
and
in the
It
is of acadlemid
infeuesf
moblasts
to
cellular
culture(l
phuology
in no)t’mal
d)f the
is
dells
seu-ies
in
agnostic
is
So
a
al.,
been
by
and
adults
of
repouted.
of both
In
and
Penati,1#{176} Moeschhin,7
Stahel.i2
The
between
a true
these
eiyt.hroidl
course
Moes-
of six
months
of Moeschlin.7
aplastic
anemia,
cases
of
in differentiating
is
ratio)
myeloid
one
w’ith
bone
a relative
(paramyeloblasfs).
neoplastic,
pu-obably
the
same
leukemia.
changes
Hence
these
of progressive,
and
n1atuuratid)n
rate
an
and!
f-lie dClls of aplast-ic
anemia,
w’heie the
how’ever,
an abnou’mal
noi-moblastic
\\Then,
since
suggested,
to flue normal
ue’euts
did)
qualitative,
value
case
cells
seu’uirn,
uenn’ed.
found!,
eryfhroblastosis,
blast
ct
that
to diffet-entiate
not-no)l)last.
fut-thet
is
rate
these
This
have
hypei-plasia
described
osis
in this case.
erythroblastic
initial
phase
of leukemia
and the mixed
neoplastic
fou-ms of the erythrogroup.
Etythiroblasts
in cases of this group
fuequenfly
show
“megaloid”
(as dlO those
in acute
leukemia).
A seiies
of transitid)nal
foi-ms
from
norto) nwgaloh)lasts
through
“megaloid!”
foins
may
be seen.
This could
be
a leltti\’(’
olehcienov
in nutritive
factors
consequent0)11 the
abnormal
prolifeu-atiotu.
Similan-ly
in ninny
types
of acute
leukemia
this type
of cell,
leukenio’
tio)n
been
lio)hul,#{176}11tu-u’ier
u’esembles
changes
defect
hyperplasia,
have
cases
euythroblast
never
present
a predominant
is neither
there
of a neoplastic
case
aplastic
when
evidlence
liohu’,5
rt-esent
where
myeloblasfic
Such
tissue.
a t u’uie d’huonic
a leukocytosis,
by
cases,
is, however,
myeloiol
genetic
Schu#{246}neu’5descu-ih)e
is aco’ompanied
propon(leututing
there
due
ttilll
lu)wever,
WhiCh,
mau-row
myeloidl
marrow’
somew’hat
irresponsive
showing
change
may
be
anemia
in
nature
the
may
cultui-e
allied
prove
w’ith
of early
a peu-ipheral
lowered
forms
leuko-
leukoerythro-
and
of
myeloid
of di-
conditions.
a considerably
pu-edominance
in the
found
mor-
ultimate
matura-
of atypical
From www.bloodjournal.org by guest on October 15, 2014. For personal use only.
E.
Culture
of the
the eryt.hroid
marked!
in the
K.
bone
BLACKBURN
mau-row’
AND
established
L.
G.
that-
the
and myeloid
tissue
u’as abnormal,
erythroid
series.
On these
findings
seems
justified.
ture have
shown
Since
this
comparable
269
LAJTHA
rate
of maturation
although
a diagnosis
the
of both
defect
was
more
of eu-yfhroleukemia
i-eport-,
2 similar
cases
investigated
maturation
al)nou’mahities.
by
marrow’
cul-
REFERENCES
1
AsTAIni,
mil
2
ANt)
G.
anid pathological
CoPEnL1,
:i.
: Di
blastica.
3
Guc,uELiuo,
4
HARVIER,
lose
coniditions.
unti
U. Di
L.
272,
15:
AND
187: 225,
Mcdl.
LEITNER,
S.
Churchill,
MOESCHLI
-
AND
E.
met-hod.
F.:
1#{176}
PENATI,
ROHR,
12
STAHEL,
1943.
E.
J.
K.:
R.:
XXIX,
LAVERGNE,
Conign.
U.
A.
in
nor-
(ha
unia
iperplasia
erit
ro-
H.
mit
med.
xo
.
Roruua,
M.
LAMOTTE,
1923.
: En’vthroleucomnv#{233}-
1942.
Die
\V.:
Process
chironiische
des
reinie
Ervthroblastose
Erythrocyt#{228}ren
BRITTON,
Eryt
C.
hrobhast
J.
C.
AND
osen,
NEIMARK,
Systems.
E.:
Erythroleukitnnieni
262, 1940.
K.: Khiniischie
und niorphologische
nieoplasma.
Ergebni.
d. inn. Med.
als
Osooo,
rappresenitata
des
Deutsche
Erwachisenien
Arch.
Bone
f. KIm.
unsd
Biopsy,
marrow
Eryt
AND
M.
BROWNLEE,
A.
108:
I.
E.:
Culture
Folia
Gesichilspunkte
u. Kinderh.
57: 723,
of
human
marrow.
zur
Auffassunig
der
1939.
Details
of
a
simple
1793, 1937.
Leucemia
megaloblastica
acuta.
Das
Menschhiche
Knochenimark,
Subakute
London,
hroblastatnieni.
64:
ROHR,
myelose
in
J.,
Lpz.
of en’vthiroblasts
1949.
1941.
1949.
S.:
N,
haemat-.
acuta.
J.,
Sd’H#{246}NER,
als Leuk#{228}mie-paralleler
naturation
2: 217,
1912.
: Eritremia
aigu#{235}.Smug
5 HEur1EYER,
ott
Path.
sistematizzata
4: 460,
LE MELLETIER,
in vitro
J. Clin.
emopatia
Pathologica
P.,
P. : Studies
TonEN’rINo,
Erythroleuk#{228}mie
Minierva
Leipzig,
ohmic
Med.
28:
G. Thiieme,
Splenuomegalie.
401,
1937.
1940.
Helv.
med.
acta.
10:
605,