Abstract
A 43-year-old male was admitted to Jichi Medical School Hospital because of pancytosis. Three years before this admission, his peripheral blood values were WBC 8,300/mm3, Hb 17.0g/100 ml. Eight weeks before the admission, WBC increased to 17,000/mm3. RBC 505×104/mm3, Hb 17.0 g/100ml and platelet 66×104/mm3.
On admission, physical examination revealed a presence of hepatosplenomegaly. RBC 539×104/mm3, Hb 15.7 g/100ml, platelet 84.8×104/mm3, WBC 20,200/mm3 with shift to the left, three per cent of eosinophils and eight per cent of basophils. Bone marrow aspiration revealed a marked increase in myeloid series of various stages and megakaryocytes. Chromosome analysis showed 46 XY with Ph1 chromosome. Leukocyte alkaline phosphatase score was 160 (normal 180∼340). Total red cell volume was 56.7 ml/kg. From these findings he was diagnosed as having chronic myelogeneous leukemia with erythrocytosis. The number of CFU-E in the marrow was increased to 596 per 1×105 bone marrow cells (control 237±47). Secondary erythrocytosis was not possible because causative diseases such as pulmonary diseases, cardiac diseases, renal diseases, hemangioblastoma or hepatoma were not found. Moreover, serum erythropoietin was not detectable by polycythemic mouse assay. This increase in the number of erythroid progenitor cells in the marrow is considered to be related to the pathogenesis of erythrocytosis observed in this case.
