[Acquired refractory anemia and neoplasms. Study of 11 cases].
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Biomedical subjects
Publications and source records attributed to S Woessner.
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We have studied the amount and intracellular distribution of erythroblastic alkaline and acid phosphatase, nonspecific esterase, and N-acetyl-beta-glucosaminidase in 50 patients with acquired dyserythropoiesis. 19 morphologically normal bone marrow smears served as controls. Alkaline phosphatase was found in all controls (mean 9.4% of erythroblasts). The percentage of positive erythroblasts in pathological conditions varied greatly from absence to over 70%. Acid phosphatase and N-acetyl-beta-glucosaminidase were positive in pernicious anaemia and in acute erythremic myelosis. Nonspecific esterase was only detected in a case of erythremic myelosis. This case also showed a faint metachromasia with the dye azure A.
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Transmission electron microscopy was used to examine marrow samples from 15 patients with aplastic anaemia or acute leukaemia who had been treated with bone marrow transplantation. There were 11 allogeneic, three syngeneic and one autologous graft. The purpose was to estimate the frequency, type and extent of dyserythropoietic change. Transient dyserythropoietic features were substantiated in all cases. Nuclear changes were present in 12 cases, iron laden mitochondria (sideroachrestic phenomena) in 10 and cytoplasmic contacts and/or connections between red cell precursors in 10. Dyserythropoiesis was most conspicuous in the majority of cases between 14 and 28 d after transplantation but it may persist for over 100 d. No deficit in red cell production was noted and it is proposed that dyserythropoiesis in this circumstance is a physiological rather than a pathological phenomenon.
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A new case of congenital dyserythropoietic anemia type I is reported in a 12-year-old Spanish boy. In regard to the morphological study at an optical and ultrastructural level, the most outstanding feature was the internuclear bridging connecting two erythroblastic nuclei within a single cytoplasm or stretched between two erythroblasts perfectly individualized.
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In 57 cases of B-type chronic lymphocytic leukaemia (B-CLL), the size of peripheral blood lymphocytes was estimated by means of transmission electron microscopy. The mean lymphocyte diameter (MLD) of 50 cells was correlated with the clinical staging as well as the survival. 30 out of 38 patients found in stages 0, I, and II displayed a normal or increased MLD. Conversely, this value was decreased in 12 out of 17 cases in stages III and IV. MLD of patients in clinical stages III and IV was significantly lower as compared with MLD of patients in stages 0, I, and II (P < 0.001). The actuarial curve of 57 patients showed a roughly estimated median survival probability of 43 months. This was of more than 54 months in patients with normal or increased MLD, but only of 22 months in those with a decreased MLD. The difference between these 2 survival curves was statistically significant (P < 0.01). A reduced peripheral blood lymphocyte size, as estimated in suspension by means of transmission electron microscopy, appears to have a bad prognostic significance.
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