[Bone marrow biopsy in the study of acquired refractory anemias].
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Biomedical subjects
Publications and source records attributed to S Woessner.
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A case of acute nonlymphocytic leukemia of megakaryocytic lineage or M7 with a conspicuous phenomenon of erythrocytic internalization present in nearly 3% of the leukemic megakaryocytic precursors (LMP) is reported. The phagocytosis was detected at light microscopy and ultrastructural levels. The erythrocyte might have reached the interior of the LMP through cytoplasmic vacuoles that are connected with the extracellular space and that can be considered rudimentary equivalents of the demarcation membrane system (DMS). Erythrocytic internalization is not a specific feature of the mononuclear phagocytic system and can be misleading in the classification of undifferentiated blast cells.
A case of acquired refractory anaemia with excess of blasts (RAEB) of the promegakaryoblastic type is described. The promegakaryoblastic origin was demonstrated by means of ultrastructural cytochemistry (platelet peroxidase) and immunological methods. The blasts were also 5'-Nucleotidase positive. After a stable course over 2.5 years the patient died from hematological failure, his marrow demonstrating a high degree of fibrosis.
The platelet peroxidase (PPO) content of circulating thrombocytes was determined in 10 healthy controls and in 18 cases of acquired refractory anaemia (2 with refractory anaemia, 4 with sideroblastic refractory anaemia, 8 with refractory anaemia with excess of blasts, 3 with refractory anaemia in transformation and 1 with chronic myelomonocytic leukaemia). The thrombocytes of the controls were invariably PPO-positive. No peroxidase deficiency was found in the 4 patients with sideroblastic refractory anaemia. Of the remaining 14 cases PPO-positive and PPO-negative thrombocytes coexisted in 8. Only in 1 case of refractory anaemia with excess of blasts were circulating platelet peroxidase-positive micromegakaryocytes demonstrated. PPO deficiency seems to be an important dysthrombopoietic feature detectable only at an ultrastructural level.
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We report a further case of a recently recognized variety of acute myelomonocytic leukaemia (M4 subtype) with bone marrow eosinophilia and inversion of chromosome 16. The eosinophils showed a distinctly abnormal morphology, cytochemical staining and ultrastructure.
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