Studies on red‐cell aplasia: IX. Ferrokinetics during remission of the disease

Abstract

Ferrokinetic studies and external organ measurements of radioiron were performed on five patients with pure red-cell aplasia (PRCA) in remission. One patient with PRCA in relapse was also studied. Of those in remission, one patient had erythroid hyperplasia and ineffective erythropoiesis after the remission occurred. This was indicated by a very short 59Fe clearance rate and reduced red-cell 59Fe incorporation, a marked increase of the erythron iron turnover over the fixed red-cell iron turnover, and a prolonged marrow transit time. These indices were normal three years later. Four patients had normal effective erythropoiesis while in remission. Two patients had an extended marrow distribution. These studies indicate that some cases of PRCA evolve into a state of ineffective erythropoiesis with erythroid hyperplasia. It is possible that in some patients, primary refractory anemia with ineffective erythropoiesis may be related to PRCA because of the evolution from one state into the other. Alternatively, a second pathologic process may have been acquired between the PRCA and normal hematopoiesis.

Red Cell Aplasia and Chronic Granulocytic Leukaemia

“…However, the patient's erythropoiesis remained ineffective. The presence of ineffective erythropoiesis before or after a period of red cell aplasia has been observed previously in patients with chronic idiopathic pure red cell aplasia (Beard et al, 1978;Wibulyachainunt et al, 1978). In the second case the administration ofprednisone was followed also by a return of erythropoiesis in the bone marrow and a sustained PCV at 37% 5 weeks after the last red cell transfusion.…”

Acquired pure red cell aplasia

“…The serum iron is elevated with increased saturation of the iron binding capacity [2], markedly prolonged plasma iron clearance [93,94] with reduced plasma iron turnover, and diminished to absent iron utilization [8,61] that is largely reversible with remission. In an occasional patient in remission, erythropoiesis may be ineffective as evidenced by rapid iron clearance but decreased utilization [95]. Marrow scans using radio iron or Indium show decreased marrow activity, which returns to normal in remission [96].…”

Dyserythropoiesis and erythroblast‐phagocytosis preceding pure red cell aplasia

“…Thus Wibulyachainunt et al [8] described a patient who had laboratory and ferrokinetic findings of ineffective erythropoiesis that lasted almost 2 years before reverting to normal. Similarly, Bottiger and Rausing [9] and Marmont et al [lo] have documented the presence of ineffective erythropoiwere also noted among early erythroid precursors (C).…”