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Our resent experience on six cases of aplastic anemia complicated with pregnancy is described. In addition, 43 similar cases were collected from the literature and reviewed to analyze some prognostic aspects of this relatively rare but potentially serious complication. Clinical and hematological data were treated to extract some clinically meaningful factors in relation to the success and failure of pregnancy. Among initial hematological parameters, no significant difference was found between successful and unsuccessful cases with an exception of hemoglobin concentration. The patients diagnosed as aplastic anemia prior to conception demonstrated an better outcome of pregnancy as well as survival rate of mother when compared with those diagnosed during pregnancy. Mortality has apparently improved after the late 1950's. Success rate of pregnancy before 1958 was 21%, while it was 67% and 71% in the era of 1959-1969 and after 1970, respectively. However, hemorrhage and infection remained to be two major causes of maternal death in both eras. Based on these observations, the currently recommendable attitude to this complication is discussed.

The proliferative kinetics of leukemic cells was investigated in the cerebrospinal fluid (CSF) and the leptomeninges of 5 patients with meningeal leukemia (ML) and 15 selected autopsies showing meningeal involvement. The 3H-thymidine labeling index (TLI), mitotic index (MI) and 3H-uridine labeling index (ULI) of leukemic cells in the CSF at the time of diagnosis were 0.7 k 0.2, less than 0.01 and 96.2 2 0.796, respectively. The TLI was found to be higher at the time of recurrence than at the initial diagnosis of meningeal leukemia. The grade of leukemic cell infiltration was classified according to Price's criteria. The mitotic index was also estimated on the histologic sections. An infiltration of Grade 2 or greater was observed in all 4 patients who had not received an intrathecal administration of methotrexate (MTX). The clinical course of 2 patients with a higher M I (0.88 and 0.32%) was shorter than the other 2 (0.03 and 0.01%). In the patients who did not show clinical manifestations of ML, the infiltration of leukemic cells in the leptomeninges was mild in degree, and the MI was less than 0.01%. Likewise, mild infiltration and low MI was observed in 8 cases treated with an intrathecal administration of methotrexate. These findings seem to support the general concept that the proliferation of leukemia cells infiltrating leptomeninges is remarkably slow at an incipient stage of ML; then it undergoes a gradual acceleration, possibly slowing down again at an advanced stage of the disease.

DNA synthesis time (Ts) and 3H‐thymidine labelling index (TLI) of erythroblasts have been determined in 25 patients with various types of haematologic disorders using in vitro double labelling method. No remarkable differences in both Ts and TLI were noted between haematologically normal subjects and patients with increased effective erythropoiesis (haemolytic anaemias), suggesting that the cell cycle time is not principally altered under the augmented erythropoiesis. In pernicious anaemia, Ts of basophilic erythroblasts was significantly shortened and TLI was elevated above normal. Normalization of erythropoiesis by vitamin B12 was associated with a transient increase of TLI in polychromatic erythroblasts, which was interpreted to reflect prevention of intramedullary premature death of basophilic megaloblasts. Erythroleukaemia showed a markedly prolonged Ts and lowered TLI indicating the presence of cells with prolonged cell cycle time. These findings contrasted to that of pernicious anaemia despite certain morphological as well as functional similarities. In idiopathic sideroblastic anaemia, prolongation of Ts was observed to a similar extent as erythroleukaemia, while TLI remained almost normal. In 2 cases with suspected erythroleukaemia presenting an intermediate clinical picture between erythroleukaemia and sideroblastic anaemia, Ts of basophilic erythroblasts was found to be prolonged along with modestly lowered TLI.

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