Cytochemical Investigations on the Blood and Bone Marrow Cells in Preleukemia — Demonstration of Maturational Anomalies

Abstract

The examination of the cytochemical patterns of the blood and bone marrow cells disclose distinct maturative anomalies undetectable by conventional morphologic examination. Such anomalies are common in acute and chronic myelogeneous leukemias as well as in other myeloproliferative disorders, including oligoblastic leukemias, CMML, and RAEB. However, they can also be detected in secondary myelodysplastic, preleukemic syndromes consequent to chemical or radiation injuries. The author focuses the attention to a third group of agnogenic myelodysplasias showing cytochemical and morphologic anomalies but without considerable accumulation of myeloblasts in the bone marrow which terminates in acute myelogeneous leukemia. The cytopenic cases out of this group have to be distinguished from true aplastic anemia not terminating in acute leukemia.

Further, maturative anomalies may occur in several secondary bone marrow disorders including severe bacterial and viral infections, metabolic disorders, and congenital anomalies of the myelopeisis. When considering the diagnosis of preleukemia, these disorders have to be excluded by careful clinical and laboratory examinations.

The combination of partial or complex bone marrow insufficiency and maturative defects can be detected several years before the manifestation of granules in neutrophils and monocytes, alterations of the polysaccharide and iron metabolism, as well as anomalies of cytoplasmic hydrolases. The evolution of the anomalies during the preleukemic phase and the increased frequency in men are discussed.