[The Zinsser-Cole-Engman syndrome. A contribution to congenital poikilodermias as well as a contribution to familial pancytopenias]

The Zinser-Cole-Engman-syndrome (Dyskeratosis congenita), which is characterized by the cardinal symptoms pigmentatio reticularis, onychodystrophia and leukoplakia oris, is discussed as a clinical entity, which is different from Fanconi's anemia and Braun-Falco-Marghescu-syndrome. A review of the literature is given.

[The colony forming cell and its stimulation--findings in hematological diseases (author's transl)]

In modifying the agar culture technique of mouse bone marrow cells Robinson et al. in 1970 described the in vitro culture of the human colony-forming cell. Since that time a number of data accumulated which markedly improved our knowledge of the regulation of normal and pathological hematopoiesis. A summary of the up-to date results is presented focusing mainly on disturbances of the colony-forming cells in peripheral blood and bone marrow of patients with hematological disorders. Furthermore, the findings on human urinary CSF excretion which exerts an action on mouse bone marrow are discribed. The somewhat contradictory results obtained with different methods are discussed in the light of the actual hypotheses.

Pure red cell aplasia

Complete or near complete remission of acquired pure red cell aplasia, not associated with thymoma, occurred in response to prednisone (six occasions), prednisone and cyclophosphamide (twice), cyclophosphamide alone (once) and splenectomy (once). These results were observed in four patients and confirm the value of cyclophosphamide and possibly splenectomy in patients resistant to prednisone in acquired red cell aplasia. In two of these patients, bone marrow progression from a state of ineffective erythropoiesis with many red cell precursors to that of red cell aplasia was observed. This indicates that some acquired refractory anaemias characterized by ineffective erythropoiesis may have the same pathogenesis as acquired red cell aplasia. The absence of demonstrable antibodies active against erythroblasts may merely reflect the insensitivity of currently available techniques. However it is possible that non-humoral immune mechanisms may be involved in the production of some forms of acquired red cell aplasia responsive to immunosuppressive drugs.

Normal erythropoietic helper T cells in congenital hypoplastic (Diamond-Blackfan) anemia

To examine the erythropoietic function of T and null cells in congenital hypoplastic (Diamond-Blackfan) anemia, we fractionated the peripheral blood of three normal subjects and three affected patients into subclasses of null, T and B cells. Mixtures of these cells were co-cultured in plasma clots in the presence of erythropoietin. Erythroid colonies grew in cultures of normal null cells if either normal or patient T cells were co-cultured with them. Null cells of patients with hypoplastic anemia did not produce erythroid colonies under any culture conditions. We conclude that in this disorder, T cells function normally as helper cells in erythropoiesis and do not suppress colony formation, whereas the erythroid progenitor cells in the peripheral blood null-cell fractions are deficient in either number of function.

[Stimulation of hematopoietic stem cells by antilymphocyte serum]

The physiopathogeny of aplastic anemia is still unknown, it can be related to a stem cell defect or a microenvironment disease. An autoimmune origin is suspected but not as yet proved. To demonstrate the autoimmune origin of some cases of aplastic anemia, we have studied the effect of antilymphocyte globulin (ALG) on the hematopoiesis of aplastic patients by serial hematological and bone marrow investigation including blood counts, bone marrow cellularity, scanning with indium and technetium and granulocytic colonies in agar, 8 out of 17 patients had a response to ALG as shown by a rise of granulocytes and reticulocytes counts, increase of bone marrow cellularity and number of granulocytic colonies. This study tends to show that ALG has a stimulating effect on hematopoiesis in some cases of severe aplastic anemia.

Cell culture studies in 19 cases of refractory aneamia: comparison of clinical data with in vivo erythrokinetic studies

A total of 19 cases of chronic refractory anaemia underwent simultaneous in vivo erythrokinetic study and in vitro bone marrow culture. They were followed up clinically for at least 2 years. Good correlation has been found between erythrokinetic data (simultaneous quantitative and qualitative disorders of erythroblastic proliferation in preleukaemic states; pure qualitative disorders in primary sideroblastic anaemia) and the results of culture of granulocyte precursors in the bone marrow (small number of colonies, reduced size of colonies in preleukaemic states; normal number and growth in non malignant refractory anaemia). It would seem thus that both examinations are of practical interest in clinical haematology, making it possible to foresee the malignant evolution of some refractory anaemias.

Granulocytic progenitor cells in aplastic anaemia

The characteristics and the concentration of granulopoietic colony forming cells (CFC) were examined in 22 patients with aplastic anaemia at different stages of their disease. Additionally the ability of the patients' peripheral leucocytes to elaborate factors necessary for colony stimulation in vitro (CSA) was studied. The ability of the patients' cells to generate CSA was shown to be unaffected. However, the incidence of CFC within the marrow and peripheral blood suspensions was significanlty reduced in all patients. The results suggest a reduced compartment size of CFC even in those patients who have recovered from aplastic anaemia. This may indicate that the disturbances in the preceding compartments of the haemopoietic cell renewal system still persist after recovery from the acute bone marrow failure.

Ferrokinetics and erythropoiesis in man: red-cell production and destruction in normal and anaemic subjects

Recent advances in the analysis of plasma 59Fe clearance have produced a unified method for measuring effective and ineffective erythropoiesis (Ricketts et al, 1975). We have used this method to investigate the balance between red-cell production and destruction in normal subjects and in patients with megaloblastic anaemia, iron deficiency anaemia, and refractory hypoplastic anaemia. The results show that the normal marrow can maintain an appropriate red-cell mass by altering red-cell production to match destruction. In the anaemias we have studied there is an increased rate of either intra- or extra-medullary red-cell destruction. The response of the marrow may be limited by iron supply, by defective nuclear maturation or by some intrinsic marrow defect.

Congenital hypoplastic anaemia with unusual dyserythropoietic features. A case report

A case of severe congenital anaemia (Hb levels 3--4 g/dl) is presented. The patient, a 21-year-old female, requires, since the age of two, periodical blood transfusions, but is nevertheless able to lead a normal life as a housewife. Although the case has to be considered as a form of congenital hypoplastic disorder of the erythroid tissue, some of the clinical and haematological features are compatible with a congenital dyserythropoietic state. On the basis of clinical findings it is suggested that it may represent a previously undescribed form of anaemia which shares the features of both hypoplastic and dysplastic congenital affections of erythropoiesis.

Aplastic anemia: presence in human bone marrow of cells that suppress myelopoiesis

Bone marrow from a patient with aplastic anemia was shown by multiple criteria to have a block in early myeloid differentiation. This block was overcome in vitro by elimination of marrow lymphocytes. Furthermore, this differentiation block was transferred in vitro to normal marrow by coculturing with the patient's marrow. We suggest that some cases of aplastic anemia may be due to an immunologically based suppression of marrow cell differentiation rather than to a defect in stem cells or their necessary inductive environment.

Fanconi's anemia. II. Are multiple endocrine insufficiencies a substantial part of the disease?

Three children with Fanconi's anemia belonging to a family where 6 children had the disease were investigated. One child had growth hormone deficiency, a second child showed subnormal response of testosterone to gonadotropin stimulation and the third child had a missing insulin release following arginine. This report shows that growth hormone deficiency is not necessarily liniked with Fanconi's anemia when it occurs in a family. Multiple endocrine insufficiencies do no appear to be part of the disease.