BACKGROUND: Macrocytic anemias are commonly seen in clinical practice, and precise etiologic diagnosis is essential for proper management. We evaluated the clinical utility of reticulocyte maturation parameters in macrocytic anemias to discriminate among myelodysplastic syndrome (MDS), megaloblastic anemia (MA), and non-megaloblastic macrocytic anemia associated with chronic liver disease (MA-CLD). METHODS: Using an automated reticulocyte counter, we retrospectively analyzed and compared reticulocyte maturation parameters including immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), mean sphered cell volume (MSCV) of normal control (N=34), and patients diagnosed with MDS (N=31), MA (N=52), and MA-CLD (N=196). RESULTS: Macrocytic anemias from MA, MDS and MA-CLD showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than normal control (P<0.01). MDS showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than MA-CLD (P<0.01). IRF and MRV were significantly lower in MA-CLD than in both MA and MDS (P<0.01). MSCV was significantly higher in MDS than in MA (P<0.01). CONCLUSIONS: This study indicates that the measurement of reticulocyte maturation parameters may be a useful tool in the differential diagnosis of macrocytic anemia. The presence of high values of IRF (> or = 0.39), MRV (> or = 129.5 fL), and MSCV (> or = 102.3 fL) makes the diagnosis of MA-CLD unlikely and underlying MDS should be considered.
Adult ; Anemia, Macrocytic/*diagnosis ; Anemia, Megaloblastic/*diagnosis ; Chronic Disease ; Diagnosis, Differential ; Female ; Humans ; Liver Diseases/*diagnosis ; Male ; Middle Aged ; Myelodysplastic Syndromes/*diagnosis ; Reticulocyte Count/*methods

OBJECTIVETo investigate the role of endothelial progenitor cell (EPC) injection in the restoration of vascular niche in bone marrow (BM) after allo-BMT in mice, and to observe its role on hematopoietic reconstitution.

METHODS6-8 weeks old female BALB/c (H-2(d)) were randomized to BMT (allo-BMT) group and combined EPC transplant (allo-BMT + EPC) group. For allo-BMT group, female BALB/c mice were lethally irradiated with 60Co source, and then were injected intravenously with 5×10(6) BM cells from donor mice. In allo-BMT + EPC group, recipient mice were injected intravenously with 5×10(6) BM cells and 5×10(5) EPC from donor mice. The recipients were monitored for histological changes of endothelial cells (EC) in BM. The recovery of hematopoiesis was determined by white blood cell counts and the proportion of reticulocytes in circulation and the proportion of hematopoietic stem cells (HSC) in BM. The histology of hematopoiesis in BM was also detected.

RESULTSThe in vitro induced EPC successfully homed to the bone marrow of recipients. The ECs of allo-BMT recipients were destructed severely, while the structures of ECs were restored in EPC treated recipients. 10 and 15 days after allo-BMT, the amount of Lin-c-kit(+)Sca-1(+) cells in the BM of the EPC treated group were (20.31 ± 2.65)×10(3) per mouse and (10.26 ± 2.19)×10(3) per mouse, while the allo-BMT group's were (9.61 ± 0.98)×10(3) per mouse and (4.09 ± 1.34)×10(3) per mouse; and 15 days after allo-BMT, the amount of white blood cell counts and proportion of reticulocytes of the EPC treated group were (1.20 ± 0.11)×10(9)/L and (2.35 ± 0.30)% comparing to the allo-BMT group which were (0.65 ± 0.10)×10(9)/L and (1.63 ± 0.20)%.

CONCLUSIONCo-transfer of donor EPC restores the ECs of bone marrow, which consequently promotes hematopoietic reconstitution in murine allo-BMT.

Animals ; Bone Marrow Cells ; cytology ; Bone Marrow Transplantation ; methods ; Endothelial Cells ; cytology ; Female ; Leukocyte Count ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Reticulocyte Count ; Stem Cell Niche ; Stem Cells ; cytology

The paramount importance of breast feeding for the health of the infants has been recognized by untritionists and physicians. Although many advantages of the breast feedng, exclusive breast feeding without weaning diet or supplement food during prolonged perind in infants may produce iron deficiencyh anemia. This study was conducted to find out the hematologic state in exclusively prolonged breast-fed infants among these anemic patients and the way of thinking about their baby's feeding method in their mothers. Mothers of the anemic patients has been surveyed with questionare. The results and problems obtained from this study are summerized as follows. 1) Among 40 patients of this study, 27 were male (67.5%) and 13 were female (32.5%). Mean age was 12.6+/-2.7 month and 9 & 11 month of age were the most common, respectively (15.0%). 2) Mean age of mothers was 29.5 year. The 25 34 year-old group was most common. 3) Education levels of mothers were primary 10%, middle 10%, high 60%, and college graduate 20%. 4) In motivatins of breast feeding. Persuasion of husband or the parent of husband' 19(47.5%). 'Convenience for use' 12 (30.0%), and 'Through mass media or public information' 9 (22.5%). 5) In the causes of prolonged breast feeding, 'Think that satisfactory nutrition for baby is possible with breast milk alone' 4(10.0%), 'Due to persuasion of husband or the parents of husband' 11 (27.5%), 'Baby did no suck milk bottle or eat other diet except breast milk' 25 (62.5%). 6) In whether or not acknowledgment of the necessity of weaning diet, 'Know it but not consider so important 22 (55.0)%, 'Do not know at all) 15 (37.5%), and 'Breast milk, that will do' 3(7.5%). 7) Hb level in patient group, from 6 to 6.9g/dl was 2 (50.0%), from 7 to 7.9g/dl was 3 (7.5%), from 8 to 8.9%g/dl was 15 (37.5%), and from 9 to 10 g/dl was 20 (50.0%). From 9 to 10g/dl was the most common. Hematologic findings were Hb 8.8+/-0.9g/dl, Hct 28.8+/-3.0%, MCV 64.7+/-6.7 fl, MCH 20.0+/-2.5pg, MCHC 30.8+/-1.5g/dl. Platelet 452.5+/-142.9x103/mm3, Reticulocyte count 1.4+/-0.6%, Fe 28.6+/-14.1 g/dl, TIBC 446.7+/-66.2 g/dl, Ferritin 10.5+/-7.0ng/ml. Transferrin saturation 6.6+/-3.5%. 8) In association with duration of breast milk feeding and hematologic findings, as duration was prolonged, Hb, Hct, MCV & MCH were significantly decreased (p<0.01).
Adult ; Anemia* ; Blood Platelets ; Breast Feeding* ; Breast* ; Diet* ; Education ; Feeding Methods ; Female ; Ferritins ; Humans ; Infant ; Iron ; Male ; Mass Media ; Milk ; Milk, Human ; Mothers ; Parents ; Persuasive Communication ; Reticulocyte Count ; Spouses ; Thinking ; Transferrin ; Weaning*