Abstract
In the past we have reported that in pernicious anemia marrow during relapse there is a pathologic hemoglobiniferous series, the megaloblastic, which is not related to the normoblastic or definitive red cell series. 1 The only thing these two series have in common is their ancestral cell, the myeloblast. The present report deals with certain observations which were made while the above mentioned work was in progress and takes into consideration pathologically altered neutrophils and megakaryocytes found in pernicious anemia marrow.
The present investigation was carried out upon nine bone marrows from patients with pernicious anemia during relapse. Six were prepared by smearing freshly aspirated sternal marrow and three were dry imprints (abklatsch). All preparations were stained with May-Grünwald-Giemsa combination of Pappenheim. The best morphological detail of marrow cells was elicited by the dry imprint method, consequently these preparations were studied more intensively than films of aspirated marrow.
Studying large neutrophils (macropolycytes) revealed that their entire life history is quite different from that encountered in normal bone marrow. As early as the leukoblast stage the nucleus has assumed a polymorphic shape as indicated by peculiar protuberances and invaginations. During the promyelocyte stage the nucleus may be shaped like a giant “stab” form. In other words, nuclear development and maturation has preceded that of the cytoplasm to such an extent the large pathologic neutrophils have skipped myelocytes and metamyelocyte stages. This particular point has been previously mentioned by Tempka and Braun. 2 Generally the arrangement of chromatin is less compact than that of corresponding stages in the normal neutrophil. The cytoplasm of promyelocytes may contain either rarified areas of light hyaloplasm or distinct vacuoles. These cytoplasmic vacuoles tend to disappear as the pathologic neutrophils mature. When these cells have obtained their full complement of granules practically all the vacuoles have vanished. Besides these vacuoles in the cytoplasm there are holes in the nuclei. These commence as a single definitely circumscribed hole in the nuclear material which later tends to become drawn out into an irregularly shaped space. Single large holes are found in some myelocytes which give them the appearance of a “doughnut”. Other pathologic neutrophils were found with three or more holes in the nucleus, each being separated from the other by a strand of chromatin material of varying thickness. It is by means of these holes in the nuclear material that the pathologic neutrophil ultimately attains the morphology of macropolycytes (II and III) described by Cooke. 3
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