The anemia of leukemia

Studies of Cellular Proliferation in Human Leukemia. I. Estimation of Growth Rates of Leukemic and Normal Hematopoietic Cells in Two Adults with Acute Leukemia Given Single Injections of Tritiated Thymidine *

“…Most previous work has centered on the pathogenesis of anemia in acute leukemia, and it is clear that there may be a number of mechanisms operative in causing anemia, aside from simple displacement of erythroid elements by leukemic cells (82)(83)(84). Regardless of the cause, one might expect the hematopoietic system to compensate for any reduction in normal cells either by increasing its rate of production or by increasing the size of its producing plant (e.g., probably by activating more stem cells or other very primitive precursors).…”

“…There thus appears to be an adequate stimulus to increase production of proerythroblasts, but the response is not adequately fulfilled. There are as yet no clues as to how leukemic cells interfere with the stem cell response, but possible mechanisms include a) competition for known essential nutrilites or for unknown factors that stimulate cellular growth (82)(83)(84)93), b) excessive synthesis of substances by the leukemic cells that might result in end-product inhibition of enzymatic activity or repression of enzymatic synthesis in the normal cells (93)(94)(95)(96), c) contact inhibition (97,98), or d) production of a growth inhibitor by the leukemic cells (99)(100)(101)(102). None of these postulated mechanisms have been proved operative in acute leukemia, and it is difficult to see how any except possibly the last could account for erythropoietic inhibition in all situations [e.g., both in cases where the marrow is densely replaced by blasts before anemia develops and in cases of "preleukemia" (103)(104)(105) where the normal elements may be reduced long before extensive infiltration occurs].…”

Anaemia in the Reticuloses

“…The commonest of these diseases to be associated with autoimmune haemolysis is chronic lymphatic leukaemia, but the association has also been described in lymphosarcoma (Troup, Swisher, and Young, 1960), Hodgkin's disease (Dacie and deGruchy, 1951 ;Rosenfield, Vogel, and Rosenthal, 1951 ;Sulzer, 1952), reticulosarcoma (Dacie, 1954), and giant follicular lymphoblastoma (Rosenthal, Pisciotta, Komninos, Goldenberg, and Dameshek, 1955). In contrast to haemolytic states without demonstrable antibodies, the autoimmune anaemia is often rapidly progressive and may occur at any stage in the progress of the underlying disease, and may indeed herald the onset of more frankly leukaemic features.…”

“…However, one estimate (Troup et al, 1960) has put the incidence of immune haemolytic anaemia in chronic lymphatic leukaemia at 14%, and the incidence of non-immune haemolytic processes at some stage in the disease will be higher. In chronic myeloid leukaemia, Hodgkin's disease, and myeloma immune haemolysis is rare, but the incidence of non-immune haemolysis may be as high as 40 % towards the end of the course of the disease.…”

Glutathione Concentration and Stability of the Red Blood Cells in Acute Childhood Leukemia

“…The patho genesis of anemia is now viewed more as a dynamic process than as a crowding out of erythroid elements [1]. Although in leukemia cellular abnormalities are by no means confined to leukocytes, little is known about the metabolism of red blood cells in this disease.…”