Document Detail

Evaluation of congenital neutropenic disorders by in vitro bone marrow culture.
MedLine Citation:
PMID:  857238     Owner:  NLM     Status:  MEDLINE    
The congenital neutropenias are a heterogenous group of diseases whose etiology and pathogenesis are largely unknown. We studied nine neutropenic patients from seven families. Evaluation included peripheral blood cell and differential cell counts, epinephrine and typhoid vaccine stimulation studies. Rebuck skin windows, and bone marrow aspirations for morphological assessment and for in vitro culture in liquid suspension and in agar plates. Parallel cultures were set up with and without colony-stimulating activity (CSA), and peripheral leukocytes were assayed for cellular production of CSA. Patients were initially classified on the basis of their clinical course: benign, mild, moderately severe, or severe disease. One patient in the moderately severe group had an immunoglobulin disorder. Morphologically normal mature granulocytes were seen in bone marrow aspirates of two patients, and maturational defects of varying degree were seen in the remaining seven. Colony formation in agar was markedly reduced below normal in three of seven, moderately reduced in two of seven, and greater than normal in two patients. Colonies in six of seven patients consisted exclusively of macrophages. Marrow from all but one of the nine patients demonstrated poor neutrophil development in suspension culture, and addition of CSA did not result in augmented granulocytic proliferation or maturation. A scheme of normal neutrophil maturation is proposed, and the nine patients were categorized according to this scheme. Four patterns of congenital neutropenia emerged: type 1 was the most benign form of disease with essentially normal clinical and in vitro parameters, and a defect considered to be due to a small committed stem cell pool, abnormal release, or excessive utilization peripherally; type 2 had mild disease with presumed defective committed stem cell differentiation along the granulocyte line; type 3 included benign to severe clinical expression with an apparent defect at the level of the committed granulocyte precursor more severe than in type 2; type 4 disease had varied clinical expression but evidence for a defect at the level of the pluripotent stem cell.
P M Falk; K Rich; S Feig; E R Stiehm; D W Golde; M J Cline
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  59     ISSN:  0031-4005     ISO Abbreviation:  Pediatrics     Publication Date:  1977 May 
Date Detail:
Created Date:  1977-06-22     Completed Date:  1977-06-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  739-48     Citation Subset:  AIM; IM    
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MeSH Terms
Agranulocytosis / diagnosis*
Blood Cell Count
Bone Marrow / immunology
Bone Marrow Cells
Bone Marrow Examination
Cell Differentiation
Cell Division
Cell Movement
Child, Preschool
Immunoglobulin A / analysis
Immunoglobulin G / analysis
Immunoglobulin M / analysis
Neutropenia / blood,  congenital,  diagnosis*
Neutrophils / immunology
Reg. No./Substance:
0/Immunoglobulin A; 0/Immunoglobulin G; 0/Immunoglobulin M

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