Blood neutrophil kinetics were studied withwith DF32P in patients with sickle cell anemia. Neutrophil concentration in venous blood samples and the size of the circulating granulocyte pool (CGP) were high normal or abnormally high in all patients. The total blood granulocyte pool (TBGP) was not increased to the same degree as the CGP so that in part, the neutrophilia associated with sickle cell anemia represents a shift from marginated to circulating blood compartments. The half disappearance time (T½) of blood neutrophils tended to be short so that with an elevated or high normal TBGP the absolute granulocyte turnover rate (GTR) tended to be increased. The fractional GTR was regularly increased. In most types of neutrophilia the T½ tends to be increased rather than shortened and the fractional GTR may be normal, decreased, or increased. The increased fractional GTR observed in sickle cell anemia suggests that the absolute increase in neutrophil loss from the blood is not merely a function of increased pool size as was suggested previouslyy.

No abstract

Leukemic reticuloendotheliosis is a distinct entity, often misdiagnosed as chronic lymphocytic leukemia or lymphoma. The neoplastic cells have a specific tartrate-resistant acid phosphatase isoenzyme by which the diagnosis may be secured. Most individuals are leukopenic, and when, as in our case, rare or no circulating cells with tartrate-resistant acid phosphatase activity are found in the peripheral blood, an alternate site must be sought. Bone marrow aspirations often result in "dry taps," however, and cryostat sections of the bone marrow biopsy necessary to demonstrate tartrate-resistant acid phosphatase activity are involved and impractical to obtain for most laboratories. This report illustrates and recommends the simple technic of imprinting the core biopsy, which yields a satisfactory sample with which the specific cytochemical activity can be demonstrated.

A patient is described who, during a three-year illness, exhibited multiple phenotypic expressions of leukemia. She was diagnosed initially as having acute lymphoblastic leukemia (ALL) followed by chronic myelogenous leukemia (CML) one and a half years later. Subsequent blast transformations were lymphoblastic, but preterminally, a myeloblastic transformation occurred. These later leukemias probably were not chemotherapy induced, because a review of her initial work-up revealed the presence of a smaller G group chromosome in 1 of 20 metaphases examined. Her clinical course also differs from the CML that presents in lymphoid blast crisis because the Philadelphia chromosome only was emerging at that point. This case illustrates the interrelationships of the various leukemias and supports the hypothesis that a totipotent stem cell may undergo leukemic transformation resulting in variable and simultaneous expressions.

A patient's clinical course with Phi‐positive chronic myelogenous leukaemia is described. Blastic transformation was associated with a double Ph1 chromosome and megaloblastosis. During remission, the megaloblastosis disappeared and the cytogenetic pattern reverted to a single Ph1 chromosome. A second blast crisis occurred terminally with a reappearance of aberrant red cell maturation and a double Ph1 chromosome and aneuploidy. The possible significance of these observations to the clone theory of blastic crisis evolution is discussed.