A 66-year-old woman presented with a 3-month history of pyrexia and cervical lymph node swelling. On examination she had lymph node swellings in the postauricular, cervical, axillar and inguinal areas, and right pleural effusion. The initial blood count revealed normal except for a slight reticulocytosis. The diagnosis of malignant lymphoma (ML. mixed, lymphocytic & histiocytic, diffuse) was confirmed by cervical lymph node biopsy, and the disease was classified into stage IV B as the result of bone marrow aspiration and lymphangiography. On the 9th day in hospital the reticulocyte suddenly disappeared, and anemia rapidly progressed. The bone marrow aspiration showed an entire lack of erythroblasts to establish the diagnosis of pure red cell aplasia (PRCA). After the first course of the combination chemotherapy with cyclophosphamide, vincristine, procarbazine and prednisolone, the lymph node swellings disappeared, and anemia improved.
The growth of erythroid progenitor cells (CFU-E) from her bone marrow showed a remakable decrease during PRCA, and was normal after the recovery from anemia. The sera obtained during PRCA significantly inhibited the growth of CFU-E from her bone marrow collected after recovery. The inhibitory factor was identified with IgG.
