Studies on Leukemia Part 2. Clinical and Statistical Observations of the Peripheral Blood Picture in Various Leukemias

The author carried out clinical and statistical observations of the peripheral blood picture in various leukemias occurring in the Chugoku-Shikoku District, with a special reference to the comparative study on the two groups treated in our department, namely, the group whose bone marrow was cultured and the other without such a culture finding. However, cases of chronic lymphocytic leukemia are not included in the present statistics as their number was trivial. 1. Hb content and erythrocyte count: The decrease in Hb content and erythrocyte count is most marked in acute myelogenous leukemia, followed by acute lymphocytic leukemia, and it is least in chronic myelogenous leukemia. The decrease in Hb and erythrocytes of monocytic leukemia occupies an intermediate position between the above two. 2. The color index: The color index is comparatively high in acute type while it tends to be lower in chronic type. 3. Leucocyte count: The aleukemic form is greatest in monocytic leukemia followed in descending order of that in acute lymphocytic leukemia and acute myelogenous leukemia, and all of these aleukemic ones occupy more than 1/3 of the total. However, in chronic myelogenous leukemia it is extremely rare to find the aleukemic form. 4. Reticulocyte count: The reticulocyte count in the peripheral blood of leukemia is generally normal or is increased. 5. Platelet count: The platelet count is about at the normal level in chronic myelogenous leukemia, and in some it is increased. However, it is decreased in all other leukemias. In monocytic leukemia it resembles that in acute type. 6. Classification of leucocytes: In acute myelogenous leukemia myeloblasts occupy a greater proportion and also matured leucocytes are quite many. Intermediate immature cells are low in percentage but it is rare not to see any intermediate immature cells. In chronic myelogenous leukemia mature neutrophils are numerous but immature neutrophils are a few in number. In acute lymphocytic leukemia a high percentage of lymphatic cells accompanied by a marked increase in lymphoblasts can be observed. In monocytic leukemia intermdiate mature cells are in a low proportion, and monoblasts are less than in acute type, presenting the characteristic intermediate between acute type and chronic type. Namely, monocytic leukemia is an intermediate type between acute leukemia and chronic leukemia, and it is difficult to divide it into acute and chronic types. 7. Relationship between the leucocyte count and leucocyte percentage: On the whole the increase in the number of leucocytes and myeloblast percentage show a mutual relationship. In monocytic leukemia those whose increase in the number of leucocytes is more marked show a greater number of monoblasts, approaching to the acute type. 8. Relationship between the leucocyte count and platelet count: There can be seen no relationship between the leucocyte count and platelet count. 9. Relationship between the leucocyte count and swelling of the spleen and lymph nodes: In acute lymphocytic leukemia the more marked is the increase in the number of leucocytes the greater is the palpitation frequency and the degere of swelling of the spleen and lymph nodes. In chronic myelogenous leukemia the degree of splenomegaly increases along with the increase in the nmnber of leucocytes.