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,
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