No abstract

No abstract

Macrocytosis, a common finding in patients without anemia or other hematologic abnormalities, is often ignored. The purpose of this prospective study was to investigate 300 consecutive, adult health-center patients with a mean cell volume (MCV) value greater than or equal to 100 fl. The incidence of macrocytosis was 2.4%. Of the 177 male and 123 female patients, only 14 (4.7%) were anemic; 80.2% of the men (89.3% of those under 60 years) and 34.1% of the women were alcohol abusers, representing the largest diagnostic group. The highest MCV value found in alcoholics without folate or vitamin B12 deficiency was 120 fl. The most useful laboratory test for identifying alcohol abuse among macrocytic patients was the measurement of serum gamma-glutamyltransferase. Of the several morphologic abnormalities in the marrow the only specific finding were vacuoles in the granulocyte or erythrocyte precursors. No underlying cause was found for macrocytosis in 6.8% of the men and 35.8% of the women. Even when it is not associated with anemia, macrocytosis should not be ignored. It may be the only indicator of a disease which often, particularly in young and middle-aged men, is alcohol abuse.

Myelomonocytic leukemia, our preferred designation for leukemia involving two or more marrow cell lines, is currently the most common type of leukemia seen at the Mayo Clinic. In an attempt to clarify the clinical picture and natural course of this myeloproliferative disorder, 132 patients first seen between 1955 and 1959 were studied. The disease, which usually had its onset after 50 years of age, was preceded in 41 patients by a preleukemic phase of variable duration. At the onset of overt leukemia, predominant involvement was of the erythrocytic and megakaryocytic compartments; during this phase the hematologic findings often suggested vitamin B12 or folate deficiency. As the disease evolved, it resembled acute granulocytic or monocytic leukemia or a mixture of these. The course, which was variable and unpredictable, ranged from a few weeks to several years.