A 56-year-old man was admitted to the Kinki University Hospital for further evaluation of suspicious of leukemia. He was well until ten months previously, when he became fatigued. Seven days before entry he was admitted to another hospital because of severe anemia, hemorrhagic tendencies and fever. The blood hemoglobin level was 2.7 g/100 ml; the white-cell count was 8,500/mm3, with 75 per cent lymphocytes, 5 per cent blast cells and 16 nucleated red-cells per 100 count of white-cells. No tear-drop shaped erythrocytes were found. A diagnosis of suspicious of leukemia was made, and he was treated with 2,200 ml of blood transfusions.
On admissoin to our hospital the liver was enlarged but the lymph nodes and spleen were not palpable. The blood hemoglobin level was 11.1 g/100 ml; the white-cell count was 3,200/mm3, with 88 per cent lymphocytes and 3 per cent blast cells. The platelet count was 5,000/mm3. Several attempts of aspiration from the bone marrow were unsuccessful. A needle-biopsy specimen of the bone marrow revealed severe myelofibrosis, with numerous megakaryocytes. Erythroblast and granulocyte elements were normal in number and in shape. The patient received blood transfusion in large quantities, but his clinical features showed no sign of improvement. He died on the 28th hospital day. At autopsy, the bone marrow disclosed a myelofibrosis that similar findings to the biopsy specimen. The spleen weighed 130 g. There were no infiltration with leukemic cells in all organs and no exhibition of extramedullary hematopoiesis in the liver and spleen.
