Pancytopenia as a clonal disorder of a multipotent hematopoietic stem cell

J Clin Invest. 1984 Jan;73(1):258-61. doi: 10.1172/JCI111199.

Abstract

Hematopoiesis was investigated in a 14-yr-old girl who had a 2-yr history of stable asymptomatic pancytopenia and who was also heterozygous at the structural locus for glucose-6-phosphate dehydrogenase (G-6-PD). There was no morphologic or cytogenetic evidence for preleukemia and no suggestion of Fanconi anemia. In the skin and sheep erythrocytes-rosetted T lymphocytes, the ratio of G-6-PD A/B activities was 1:1. However, only type B activity was found in peripheral blood erythrocytes, granulocytes, and platelets. Most erythroid bursts and all granulocyte/macrophage colonies formed in methylcellulose culture were derived from the abnormal clone. These findings demonstrate that (a) some cases of pancytopenia are stem cell diseases that apparently develop clonally; (b) circulating differentiated cells originate from this clone; (c) despite a hypoproliferative anemia, the in vivo expression of presumably normal (nonclonal) progenitors is suppressed. In this patient, the relationship between clonal dominance and possible malignancy may be assessed prospectively.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bone Marrow / enzymology
  • Bone Marrow / pathology
  • Child
  • Clone Cells / enzymology
  • Clone Cells / pathology
  • Colony-Forming Units Assay
  • Female
  • Glucosephosphate Dehydrogenase / blood*
  • Glucosephosphate Dehydrogenase / genetics
  • Hematopoietic Stem Cells / enzymology
  • Hematopoietic Stem Cells / pathology*
  • Humans
  • Isoenzymes / blood*
  • Isoenzymes / genetics
  • Pancytopenia / blood*
  • Pancytopenia / enzymology
  • Pancytopenia / genetics

Substances

  • Isoenzymes
  • Glucosephosphate Dehydrogenase