Abstract

Two cases of preleukemia diagnosed by authors at the Seoul National University Hospital are presented with clinical summary, laboratory results, hematological findings of peripheral blood and bone marrow as well as literature review. The results are summarized as follows. 1) The patients were 27 year old male and 43 year old female. 2) The duration from the onset of initial symptoms to the final diagnosis of acute leukemia was 10 months and 13 months respectively. 3) Initial clinical manifestations were general malaise, bleeding tendency and fever. Hepatomegaly or lymphadenopathy was not the feature of these two cases. 4) Peripheral blood showed pancytopenia in one case and anemia with leukocytosis in another case. Immature erythroid and myeloid cells were observed in peripheral blood smears of both patients with transient monocytosis. Examination of mean corpuscular volume of red blood cell exhibited normocytic to macrocytic and mild anisocytosis with poikilocytosis was their another feature. 5) Bone marrow examination showed hypocellular marrow in one case and normoceilular marrow in another case. Erythroid hyperplasia with megaloblastoid change was observed in both cases. One case exhibited the pattern of maturation arrest in myeloid series. 6) The initial hematological findings of these preleukemia cases were very similar to those of vitamine B12 or folate deficiency, however the treatment with appropriate anti-anemic preparations was ineffective. 7) Most of the preleukemia cases previously reported were diagnosed retrospectively because of the diagnostic difficulties, however authors believe that a keen attention with the understanding of specific hematological features of the preteukemia will discover more cases of this very important disease entity. Hematological features of these preleukemia cases are suggestive of or similar to those of refractory anemia, sideroblastic anemia, aplastic anemia or hypersplenism.