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Simultaneous Disparity of Bone Marrow Specimens in Acute Leukemia FREE

R. Beverly Raney, MD; Campbell W. McMillan, MD; FREDERIC N. SILVERMAN, MD
[+] Author Affiliations

Received for publication June 17, 1968.

Reprint requests to North Carolina Memorial Hospital, Chapel Hill, NC 27514 (Dr. McMillan).


Am J Dis Child. 1969;117(5):548-552. doi:10.1001/archpedi.1969.02100030550008.
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THE purpose of this report is to describe atypical bone marrow findings in a child with acute leukemia. On two separate occasions marrow aspirates revealed the simultaneous occurrences of two distinct pathological processes, viz, undifferentiated leukemia and normoblastic erythroid hyperplasia. The bone marrow picture in this patient, unusual although not unique, raises many questions and affords some insights into acute childhood leukemia.

Methods  Bone marrow aspirates were obtained from the left and right posterior iliac crests following the procedure of Bierman and Kelly.1 The alkaline phosphatase activity of neutrophils in peripheral blood smears was determined by Kaplow's method2; the method of Sheehan and Storey3 was used to ascertain Sudan black B affinity of marrow blast cells. Starch-gel electrophoresis of a stroma-free hemolysate for hemoglobin type, and of serum for haptoglobin detection, was performed according to the procedure of Smithies.4 Red blood cell (RBC) glucose-6-phosphate dehydrogenase (G-6-PD)

REFERENCES

Bierman, H.R., and Kelly, K.H.:  Multiple Marrow Aspiration in Man From the Posterior Ilium , Blood 11:370-374 ( (April) ) 1956;.
Kaplow, L.S.:  A Histochemical Method for Localizing and Evaluating Leukocyte Alkaline Phosphatase Activity in Smears of Blood and Bone Marrow , Blood 10:1023-1029 ( (Oct) ) 1955;.
Sheehan, H.L., and Storey, G.W.:  An Improved Method of Staining Leucocyte Granules With Sudan Black B , J Path Bact 59:336-337 ( (April) ) 1947;.
Smithies, O.:  Zone Electrophoresis in Starch Gels and Its Application to Studies of Serum Proteins , Advances Protein Chem 14:65-113, 1959;.
Kirkman, H.N., and Riley, H.D.:  Congenital Nonspherocytic Hemolytic Anemia , Amer J Dis Child 102:313-320 ( (Sept) ) 1961;.
Caffey, J., and Silverman, F.N.: Pediatric X-Ray Diagnosis , ed 5, Chicago: Year Book Medical Publishers, Inc., 1967;, p 1041.
Hayhoe, F.G.J.; Quaglino, D.; and Doll, R.: The Cytology and Cytochemistry of Acute Leukemias , London: F. Mildner and Sons, 1964;, pp 100-101.
Harris, R.S., et al:  A Quantitative Comparison of the Nucleated Cells in the Right and Left Humeral Bone Marrow of the Guinea Pig , Blood 9: 374-378 ( (April) ) 1954;.
Hulse, E.V.:  Quantitative Cell Counts of the Bone Marrow and Blood and Their Secular Variations in the Normal Adult Rat , Acta Haemat 31: 50-63 ( (Jan) ) 1964;.
Pizzolato, P., and Stasney, J.:  Quantitative Cytologic Study of Multiple Sternal Marrow Samples Taken Simultaneously , J Lab Clin Med 32:741-748 ( (June) ) 1947;.
Rheingold, J.J.; Weisfuse, L.; and Dameshek, W.:  Multiple Sites for Bone-Marrow Puncture, With Particular Reference to Children , New Eng J Med 240:54-56 ( (Jan 13) ) 1949;.
Bernard, J., and Boiron, M.:  Les anémies préleucoblastiques de la leucose aiguë , Sangre 25: 797-825 (No. (8) ) 1954;.
Nies, B.A., et al:  The Persistence of Extra-medullary Leukemic Infiltrates During Bone Marrow Remission of Acute Leukemia , Blood 26:133-141 ( (Aug) ) 1965;.
Stodtmeister, R., and Büchmann, P., cited in Rebuck, J.W.; Bethell, F.H.; and Monto, R.W.: The Leukemias: Etiology, Pathophysiology, and Treatment , Henry Ford Hospital International Symposium, New York: Academic Press, Inc., 1957;, p 494.
Cazal, P.:  Les syndromes médullaires topographiquement dissociés et l'Intérêt des ponctions médullaires multiples , Sangre 21:460-463 (No. (5) ) 1950;.
Hashimoto, M.:  Pathology of Bone Marrow , Acta Haemat 27:193-216 ( (April) ) 1962;.
Mathé, G., et al:  Extensive Histological and Cytological Survey of Patients With Acute Leukemia in "Complete Remission," Brit Med J 1:640-642 ( (March 12) ) 1966;.
Bernard, J., and Mathé, G.:  La discordance des moelles au cours des leucoses aiguës , Bull et Mém Soc Méd Hôp Paris 67:1285-1291 ( (Nov 16) ) 1951;.
Meacham, G.C., and Weisberger, A.S.:  Early Atypical Manifestations of Leukemia , Ann Intern Med 41:780-797 ( (Oct) ) 1954;.
Lewis, I.C.:  Leukaemia in Childhood: Unusual Modes of Presentation , Med J Aust 2:21-23 ( (July 2) ) 1960;.
Bierman, H.R.:  Hypothesis: The Leukemias: Proliferative or Accumulative? , Blood 30:238-250 ( (Aug) ) 1967;.

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References

Bierman, H.R., and Kelly, K.H.:  Multiple Marrow Aspiration in Man From the Posterior Ilium , Blood 11:370-374 ( (April) ) 1956;.
Kaplow, L.S.:  A Histochemical Method for Localizing and Evaluating Leukocyte Alkaline Phosphatase Activity in Smears of Blood and Bone Marrow , Blood 10:1023-1029 ( (Oct) ) 1955;.
Sheehan, H.L., and Storey, G.W.:  An Improved Method of Staining Leucocyte Granules With Sudan Black B , J Path Bact 59:336-337 ( (April) ) 1947;.
Smithies, O.:  Zone Electrophoresis in Starch Gels and Its Application to Studies of Serum Proteins , Advances Protein Chem 14:65-113, 1959;.
Kirkman, H.N., and Riley, H.D.:  Congenital Nonspherocytic Hemolytic Anemia , Amer J Dis Child 102:313-320 ( (Sept) ) 1961;.
Caffey, J., and Silverman, F.N.: Pediatric X-Ray Diagnosis , ed 5, Chicago: Year Book Medical Publishers, Inc., 1967;, p 1041.
Hayhoe, F.G.J.; Quaglino, D.; and Doll, R.: The Cytology and Cytochemistry of Acute Leukemias , London: F. Mildner and Sons, 1964;, pp 100-101.
Harris, R.S., et al:  A Quantitative Comparison of the Nucleated Cells in the Right and Left Humeral Bone Marrow of the Guinea Pig , Blood 9: 374-378 ( (April) ) 1954;.
Hulse, E.V.:  Quantitative Cell Counts of the Bone Marrow and Blood and Their Secular Variations in the Normal Adult Rat , Acta Haemat 31: 50-63 ( (Jan) ) 1964;.
Pizzolato, P., and Stasney, J.:  Quantitative Cytologic Study of Multiple Sternal Marrow Samples Taken Simultaneously , J Lab Clin Med 32:741-748 ( (June) ) 1947;.
Rheingold, J.J.; Weisfuse, L.; and Dameshek, W.:  Multiple Sites for Bone-Marrow Puncture, With Particular Reference to Children , New Eng J Med 240:54-56 ( (Jan 13) ) 1949;.
Bernard, J., and Boiron, M.:  Les anémies préleucoblastiques de la leucose aiguë , Sangre 25: 797-825 (No. (8) ) 1954;.
Nies, B.A., et al:  The Persistence of Extra-medullary Leukemic Infiltrates During Bone Marrow Remission of Acute Leukemia , Blood 26:133-141 ( (Aug) ) 1965;.
Stodtmeister, R., and Büchmann, P., cited in Rebuck, J.W.; Bethell, F.H.; and Monto, R.W.: The Leukemias: Etiology, Pathophysiology, and Treatment , Henry Ford Hospital International Symposium, New York: Academic Press, Inc., 1957;, p 494.
Cazal, P.:  Les syndromes médullaires topographiquement dissociés et l'Intérêt des ponctions médullaires multiples , Sangre 21:460-463 (No. (5) ) 1950;.
Hashimoto, M.:  Pathology of Bone Marrow , Acta Haemat 27:193-216 ( (April) ) 1962;.
Mathé, G., et al:  Extensive Histological and Cytological Survey of Patients With Acute Leukemia in "Complete Remission," Brit Med J 1:640-642 ( (March 12) ) 1966;.
Bernard, J., and Mathé, G.:  La discordance des moelles au cours des leucoses aiguës , Bull et Mém Soc Méd Hôp Paris 67:1285-1291 ( (Nov 16) ) 1951;.
Meacham, G.C., and Weisberger, A.S.:  Early Atypical Manifestations of Leukemia , Ann Intern Med 41:780-797 ( (Oct) ) 1954;.
Lewis, I.C.:  Leukaemia in Childhood: Unusual Modes of Presentation , Med J Aust 2:21-23 ( (July 2) ) 1960;.
Bierman, H.R.:  Hypothesis: The Leukemias: Proliferative or Accumulative? , Blood 30:238-250 ( (Aug) ) 1967;.

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