Blood and bone marrow granulocyte colony forming units (CFUc) were assayed in 46 patients with aplastic anemia, and the serum was examined for its inhibitory action on normal CFUc growth. All patients showed a gross reduction in colonies and clusters in incidence and absolute number in the bone marrow and blood. Two proliferative abnormalities of CFUc in aplastic anaemia were identified: a significantly higher than normal cluster to colony ratio (P less than 0.05) and a higher than normal ratio of granulocytes to total aggregates in the bone marrow. Eleven out of 34 patients tested had serum inhibitory to normal CFUc. These patients were indistinguishable from the rest on haematological and CFUc culture characteristics, and no correlation between the results of CFUc assay and haematological severity was found. The results suggest that the CFUc is abnormal in aplastic anaemia, the reduction in pool size being related to a failure of self-renewal, but an immunological role in the pathogenesis of aplastic anaemia remains unproven. The close relationship of CFUc incidence to the percentage of granulocyte precursors in the marrow, together with the failure of the CFUc assay to predict clinical severity, limits the practical use of the assay to the confirmation of diagnosis in aplastic anaemia.
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