CASE REPORT3-0H PA, 3-0H propionic acid CSA, colony stimulating activity Hgb, hemoglobin WBC, white blood cell count LDH, lactate dehydrogenase PCM, placenta-conditioned medium MNC, nonadherent mononuclear cells Hematologic abnormalities occur in certain inborn errors of amino acid metabolism. Reversible neutropenia, thrombocytopenia, and, rarely, pancytopenia have been described in a number of children wtih methylmalonic, isovaleric, and propionic acidemia (1-3), but the underlying hematologic defects responsible have not been widely investigated. Recent studies by Inoue et al. (4) and Hutchinson et al. (5) suggest that inhibition ofBM stem cell proliferation by the excess organic acids may be involved. In the present study, we examined the hematologic abnormalities of an infant with propionic acidemia and investigated the effects of certain organic acids associated with propionic acidemia on hematopoiesis in vitro. E. B., a 31-day-old black female was admitted to the pediatric service following 7 days of vomiting, increasing somnolence, and one episode of hematemesis. The child was the 3.76 kg product of a normal pregnancy with poor weight gain since birth. She was lethargic, hypotonic, and pale on admission without fever, lymphadenopathy, hepatosplenomegaly, petechiae, or purpura. Laboratory evaluation included a Hgb of 11.7 g/dl, reticulocyte count of 0.2%, and a negative direct and indirect antiglobin test. Her WBC was 3400/JLI with 17% polys, 1% bands, 66% lymphs; platelet count was 18,000/JLI. Serum bicarbonate, SGOT, SGPT, bilirubin, creatinine, and electrolytes were normal, as were the spinal fluid cell count, protein, and glucose. Serum ammonia was minimally elevated and LDH was one and a half times normal. Blood, urine, and spinal fluid cultures for bacteria and nasopharyngeal, urine, and rectal cultures for virus were negative.Several days of persistent neutropenia, thrombocytopenia, progressive anemia, and the development of hepatomegaly led to further hematologic evaluation. The peripheral blood smear showed moderate anisocytosis and poikilocytosis of red cells with tear-drop forms, without fragments or spherocytes. White blood cells and platelets appeared normal. Light microscopy of the BM aspirate and biopsy revealed trilineage dysmyelopoiesis, hemophagocytosis, and numerous large bizarre multinucleated cells. Peripheral blood and BM chromosomes were normal.
783ABSTRACT. This study investigated the hematologic abnormalities of an infant with propionic acidemia and reversible pancytopenia. Light and electron microscopy of her bone marrow revealed severely disturbed cellular morphology with trilineage dysmyelopoiesis, hemophagocytosis, and numerous multinucleated histiocytes and megakaryocytes. The effects of her serum and of organic acids associated with propionic acidemia were studied on hematopoiesis in vitro. Mouse erythroid (CFU-E) and granulocyte-monocyte colonies (CFU-GM) were assayed by fibrin clot technique; human CFU-GM were grown in agar culture. The infant's serum reduced mouse CFU-E...