Abstract

Since the description of acute erythremic myelosis by Di Gug1ielmo in 1928, several different and overlapping terms including erythroleukemia, erythremic myelosis, Di Guglielmo's disease and Di Guglielmo's syndrome have been used to encompass this entity. During the past ten years from January 1971 to December 1980, we have experienced 13 cases of erythroleukemia which were diagnosed in the course of the routine tone marrow studies at the Catholic Medical Center in Seoul. This 13 cases occupied 3.4% of all leukemia diagnosed by the routine bone marrow studies during the same 10 year period. Of the 13 cases, there were 9 males and 4 females Cases were distributed in all age groups from the first to the fifth decade and 5 of the 13 cases were found in the first decade. The chief complaints at the time of first admission were pallor (77%), general weakness(39%), fever(39%), dyspnea(32%), and bleeding tendency(31%). There were hepatomegaly in 10 cases(77%), splenomegaly 6 cases(46%) and petechia or ecchymosis 5 cases (39% ). The peripheral blood findings are summarized in Table 6. In the majority of the cases, the type of the anemia was of normocytic and normochromic type. However, mild to moderate degree of reticulocytosis was found in the majority of the cases suggestingan excessive hemolytic process. Nucleated red blood cells were found in all of 13 cases. The leukocyte count varies from subnormal count to moderately increased number, and leukemic cells, mostly leukemic myeloblasts and occasionally leukemic progranulocytes were found in all but one cases in our series. Platelets were decreased in number in 9 of the 13 crises. The bone marrow findings showed about 100% cellularity of the tissue section particles and showed marrow cell hyperplasia virtually in all of our crises. The relative number of the erythroblasts stowed a marked variation, in some cases occupying more than 90% of all nucleated elements. In other cases, the erythrocytic hyperplasia was of a less marked degree. And in still other cases, leukemic cells outnumbered the erythrocytic precursors. The megalotlastoid pictures of the erythrocytic precursors were found in all of the cases. The leukemic myeloblasts were found in almost all cases, though the relative number and the degree of anaplasia varied according to the individual cases. In one case, the morphology of the leukemic cells showed rather distinct myelomonocytic appearance. And one patient showed myelofibrosis in the course of the disease.