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Inhibition of CFU‐GM by prostaglandins in a case of chronic T‐cell lymphocytosis and neutropenia
Author(s) -
Smith J. G.,
Smith M. A.,
James I.,
Blundell E.,
Maddison P. J.
Publication year - 1989
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1989.tb00244.x
Subject(s) - lymphocytosis , neutropenia , medicine , phytohaemagglutinin , immunology , bone marrow , cfu gm , absolute neutrophil count , cd8 , lymphocyte , biology , haematopoiesis , antigen , toxicity , stem cell , genetics
Summary A 45‐year‐old Caucasian female with seropositive rheumatoid arthritis was found coincidentally to have a circulating lymphocytosis (6.4 × 10 9 /1) and neutropenia (0.1 × 10 9 /1). Initial presentation was with mouth ulceration and recurrent infections. A spleen scan showed no evidence of splenomegaly and serum titres against EBV, CMV and toxoplasmosis were negative. No anti‐neutrophil antibodies were found. Marrow aspiration demonstrated a lymphocytosis of 60% with reduced numbers of granular precursors. Lymphocytes in both blood and bone marrow were CD3, CD8, CD16 and HLA‐DR positive. Lymphocyte conditioned medium (LCM) generated from the patient's blood lymphocytes (without phytohaemagglutinin) was found to inhibit allogeneic colony‐forming unit, granulocyte‐macrophage (CFU‐GM) stem cells in semi‐solid culture compared with control LCM. This inhibitory activity was abrogated by the cytolytic removal of CD8 cells prior to LCM production and was significantly reduced by co‐culture with indomethacin. Culture of the patient's marrow at autostimulatory light density marrow cell concentrations showed poor spontaneous CFU‐GM colony formation until marrow CD8 lymphocytes were removed cytolytically. Prednisolone was used therapeutically (40 mg/d) and resulted in the patient's neutrophil count rising from 0.06 × 10 9 /1 to 1.1 × 10 9 /1 and a fall in the total lymphocyte count to 1.9 × 10 9 /1. Re‐evaluation of the patient's LCM post steroid therapy showed loss of the previous inhibitory effect. The patient's neutrophil count is maintained on oral azathioprine and indomethacin.