Conclusion
Lithium is a safe drug to use and results so far fully justify continued experimentation with this agent in a variety of haematological disorders. The major haematological effect of lithium in man is stimulation of granulopoiesis, the most likely mode of action being an enhancement of CSA production. Consistent with this view is the observation that neutropenic states most likely to benefit from lithium treatment are those where impaired CSA activity is demonstrable. While the physiological importance of CSA is still not completely understood experience with lithium would support a major role for CSA in the regulation of granulopoiesis. Colony-stimulating factors are produced by monocyte-macrophages, lymphocytes, and endothelial cells. Further work will be required to define the physiological significance and effect of lithium on CSA production by each of these cell types.
The success of lithium in protecting granulopoiesis following cancer chemotherapy suggests that CSA production is suboptimal in this situation. Defective CSA production may be an important and hitherto unrecognised effect of cancer chemotherapeutic agents and further studies are indicated.
There is little evidence that lithium directly affects pluripotent stem cells in man, and it is clearly without effect in most cases of severe aplastic anaemia where stem-cell failure is almost total. However, the inhibitory action of lithium on suppressor lymphocytes might be put to therapeutic use in pure red cell aplasia or in cases of aplastic anaemia where inhibition of erythroid or granulocyte precursor cells can be unequivocally demonstrated in co-culture.
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Barrett, A.J. Haematological effects of lithium and its use in treatment of neutropenia. Blut 40, 1–6 (1980). https://doi.org/10.1007/BF01028358
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DOI: https://doi.org/10.1007/BF01028358