Oxygen and the Control of Red Cell Production in Primary and Secondary Polycythemia: Effects on the Iron Turnover Patterns with Fe⁵⁹ as Tracer

Characteristics of marrow production and reticulocyte maturation in normal man in response to anemia

“…The results would support the previous conclusion that the plasma iron turnover reflects the level of erythroid marrow activity (6)(7)(8)(9)(10)13). Over a wide range of marrow production levels, there was excellent correlation between the plasma iron turnovers and the marrow production level as estimated from the level of daily phlebotomy required to maintain the hematocrit at a Hemotocrit (%) FIGURE 6 Marrow iron transit times were measured at hematocrit levels ranging from 45 to 25%.…”

“…However, this conclusion is based primarily on measurements in pathological states (1)(2)(3)(4)(5). Studies of the normal marrow have been restricted to characterization of basal production and the acute response of marrow to sudden anoxia, phlebotomy, or transfusion polycythemia (1)(2)(3)(6)(7)(8)(9)(10). As for the reticulocyte count, it has generally been discarded because of a poor correlation with the other production measurements (11,12).…”

Polycythemia vera: myths, mechanisms, and management

“…Thus, in 1928, an authoritative review of the disease stated "One must conclude that while venesection is an important and useful in relief in emergency in the treatment of these patients, it cannot be looked upon in any other light than as a further, and therefore undesirable stimulant to new blood formation." 159 This contention, reaffirmed more than once in modern times in the absence of any data, 87,145,148,290 is, of course, erroneous, since bone marrow function in polycythemia vera, as in the other myeloproliferative disorders, is autonomous and erythropoiesis can neither be suppressed by hyperoxia 10,291 nor substantially stimulated by hypoxia 292 or phlebotomy, 12,13,293 and this appears to be true for thrombopoiesis as well in the absence of anemia. 150,182,[293][294][295] Second, it has been contended that phlebotomy provokes hypercoagulability.…”

Control of marrow production by the level of iron supply

“…Whereas the iron delivered from normal reticuloendothelial stores or orally administered iron is sufficient for a marrow production response of only two to three times normal, the increased iron supply from nonviable red cells, hemolysis, or iron dextran infusions permits marrow production to rise acutely to levels of four to eight times normal. INTRODUCTION Although erythropoiesis has been extensively studied in a wide spectrum of disease states (1)(2)(3)(4)(5)(6)(7), there have been very few studies of the characteristics of the normal marrow response to varying degrees of anemia (8)(9)(10)(11)(12)(13)(14)(15). The wide variation in the level of red cell production which occurs with different anemias has been considered to be a function of both the relative level of hematocrit depression and a variety of biochemical abnormalities and cofactor deficiencies which interfere with cell growth and maturation.…”