Abstract
A 72-year-old male was admitted for the evaluation of anemia. Peripheral blood on admission showed Hb 6.2 g/dl, platelet 16×104/μl and WBC 5,300/μl with an almost normal differentials. Bone marrow revealed normocellularity consisted of 48.8% erythroblasts with a few megaloblastoid forms and 11.4% blastic cells. Some of blastic cells contained Auer bodies. Seventy two % of erythroblasts were ringed sideroblasts. Levels of both urinary polyamine and its fraction putrescine were extremely elevated. He was diagnosed as having RAEB-T according to the FAB classification, and blood transfusions were instituted with subsequent rapid, but transient decrease of erythroblasts and gradual increase of blastic cells in the marrow. Several months later, bone marrow showed 25.2% blastic cells, thus being compatible with the diagnosis of AML, M6 by the revised FAB classification. It is of interest in this case that urinary polyamine levels declined to the normal value as the bone marrow erythroblasts decreased.
It is well known that AML, M6 usually progresses through 3 stages in the successive order of pure erythremic, erythroleukemic and leukemic picture. Therefore, pure erythremic stage might be difficult in distinguishing from MDS. In view of the reports that urinary polyamine levels are high in neoplasia including acute leukemia but not in MDS, it is able to infer from our case that bone marrow erythroblasts were possessed of possibly neoplastic disturbance already at the initial stage. Determination of urinary polyamine may be useful in distinguishing AML, M6 from MDS.
