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The earliest stage of leukemia is unknown. Cases are not uncommon in which an aleukemic blood picture (that is, one showing no increase in the total number of leukocytes but a relative increase in the lymphocytes) has later developed into a typical lymphatic leukemia. Not only this, but there is so close a resemblance between the blood picture and pathologic lesions of aplastic anemia and those of aleukemic (sublymphemic) leukemia, that there is a fair suspicion that the two diseases have some sort of pathogenic relationship.
In aplastic anemia one of the striking features is the great diminution of the granulated leukocytes in the circulation. Within the last few years our understanding of the probable pathogenesis of this has been greatly increased by Selling's studies on benzol poisoning. Benzol (benzene, C6H6) is an agent which destroys circulating polymorphonuclear leukocytes as well as the leukoblastic tissue of the
PACKARD M, OTTENBERG R. THE LEUKOTOXIC FACTOR IN LYMPHATIC LEUKEMIA. JAMA. 1917;LXVIII(13):954–955. doi:10.1001/jama.1917.04270030286002
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