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May 15, 1967

Increased Red Blood Cell Production in Chronic Myelocytic Leukemia

Author Affiliations

From the Department of Medicine, Denver Veterans Administration Hospital (Dr. Goodman) and the University of Colorado Medical Center, Denver, (Dr. Goodman and Dr. Block). Dr. Goodman began this work while he was a Public Health Service fellow in hematology.

JAMA. 1967;200(7):621-624. doi:10.1001/jama.1967.03120200099022

One of us (M.H.B.) had observed that the number of erythroblasts is increased in the marrow of patients with chronic myelocytic (granulocytic) leukemia who have bled chronically. This erythroblastic hyperplasia, in patients with a malignant proliferation of granulocytes, has considerable theoretical significance. In three cases of chronic myelocytic leukemia increased red blood cell production and erythroblastic hyperplasia resulted from chronic bleeding. In one case the bleeding was spontaneous; in the other two cases repeated phlebotomies were done to stimulate erythropoiesis.

Materials and Methods  One unit of whole blood (500 ml) was removed each week from two patients (cases 1 and 2) unless hemoglobin level was considerably lower than the previous week, or unless it was below 11.0 gm/100 ml. The iron lost at each phlebotomy was replaced intravenously with 5 ml of iron dextran injection (Imferon) containing 250 mg of elemental iron. We occasionally gave iron dextran injection even when