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A prospective study of the value of bone marrow erythroid progenitor
cultures in polycythemia
F Lemoine, A Najman, C Baillou, J Stachowiak, G Boffa, P Aegerter, L Douay, JP Laporte, NC Gorin and G Duhamel
The diagnostic value in polycythemia of the presence of endogenous
erythroid colonies derived from bone marrow cells (EECs) was assessed in a
prospective study on 108 patients referred for polycythemia (Hb greater
than g/dL in men, greater than 16 g/dL in women) with normal plasma volume
by comparison with the standard criteria, the bone marrow grade, and the
serum erythropoietin (Epo) level. Total red cell volume (TRCV) was high
(greater than 36 mL/kg in men, 32 mL/kg in women) in 87 cases (group A) and
slightly increased in 21 cases (group B). Standard criteria were applicable
in 63 of 108 cases (57%); 46 were PV and 17 were secondary polycythemia
(SP). Standard criteria were nonapplicable in 45 cases. EECs were present
in 65 cases (60%) with a ratio of EEC/Epo-stimulated colonies of 39.5% +/-
18% (extremes 10% to 80%). EECs were noted in 43 of 46 polycythemia vera
(PV) and 0 of 17 SP. Among the 45 unclassified cases, EECs were noted in
22: 18 of 29 cases from group A (10 with 2 major and 1 minor criteria; 8
with 2 major criteria) and 4 of 16 cases from group B (with variable
standard criteria, 2 belonging to a PV family). In group A, there was a
positive significant correlation between EECs and the presence of two major
and 1 minor criteria (P less than .0001). In group B, there was a positive
significant correlation between EECs and the presence of at least 1 major
criterion and 2 minor criteria or a family background (P less than .0001).
The unclassified polycythemias with EECs in the bone marrow are
characterized by a bone marrow grade and a mean serum Epo level not
different from that of patients with PV and an active course of the
disease. The unclassified polycythemias without EECs in the bone marrow are
a heterogeneous group corresponding in some cases to SPs of unknown origin
(slightly increased bone marrow grade and/or high serum Epo level), and in
others cases to spurious polycythemias (normal bone marrow grade and/or
normal Epo level). In conclusion, EECs were of great value in
differentiating PV from SP (P less than .001), and in allowing the
diagnosis of PV in the absence of all the standard criteria even when TRCV
was slightly increased. In our study, EEC improved the classification of
polycythemia by 22%. The recommended diagnostic steps for the evaluation of
polycythemia must be reconsidered.
Volume 68,
Issue 5,
pp. 996-1002,
11/01/1986
Copyright © 1986 by The American Society of Hematology
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