Erythropoiesis has been studied by the technique of combined Feulgen microspectrophotometry and 3H-TdR autoradiography in nine children with Pthalassaemia. A major kinetic aberration was demonstrated in the early polychromatic erythroblasts, which showed an accumulation in G, and a marked decrease in the proportion of cells in DNA synthesis, indicating an arrest of proliferation in these cells. In scven of the cases studied there was also an increased frequency of G, cells relative to the small number in DNA synthesis, suggesting a failure to enter mitosis.The death of these arrested cells could account for the ineffectiveness of erythropoiesis in this disease. Low serum folate levels were found in all the patients who were not already on folate therapy, but the disturbance in cell proliferation persisted after the administration of folic acid.Ferrokinctic and porphyrin excretion studies have shown that ineffective erythropoiesis is an important factor in the pathogenesis of the anaemia in P-thalassaemia (Sturgeon & Finch, 1957; Grinstein ct al, 1960;Malamos et al, 1961) and indicate that, in addition to the impairment of P-chain synthesis, there must also be a disorder of erythroblast proliferation in this disease. This paper describes the results of a study of erythroblast proliferation in P-thalassaemia, using a combination of quantitative cytochemistry and autoradiography. The value of this technique in the detection of disturbances in cell proliferation has been established in previous studies of pernicious anaemia and sideroblastic anaemia (Menzies ct al, 1966;Bock et al, 1967;Yoshida et a/, 1968;Wickramasinghe et al, 1968a Wickramasinghe et al, , b, 1969.
MATERIAL A N D METHODSPatients. Eight patients with 8-thalassaemia major and one patient with homozygous thalassaemia intermedia (Case 9) have been studied; these children were either Greek or Turkish Cypriots resident in London. The pertinent haematological data at the time of the initial bone-marrow analysis are summarized in Table I. Apart from Case 9, who was receiving regular folate therapy, all patients had serum folate levels below the normal range. In six of these patients, the investigation was repeated following the oral administration of folic acid, 13 mg daily for at least 6 weeks.Cell cycle distribution. The method used for the determination of the distribution of erythroblasts in interphase-G,, S, G,, and U-was a modification of that described previously (Wickramasinghe et al, 1968a). GI represents post-mitotic cells with a diploid (2. ) DNA 719