PEDIATRICS Vol. 23 No. 2 February 1959, pp. 314-322
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SERIAL STUDY OF BONE MARROW IN HEMOLYTIC DISEASE OF THE NEWBORN (ERYTHROBLASTOSIS FETALIS)

Hugh C. Dillon M.D.1 and William Krivit M.D., Ph.D.1

1 Department of Pediatrics, School of Medicine, University of Minnesota

Fourteen infants with erythroblastosis fetalis were studied with particular reference to bone marrow activity and its relation to anemia in the infants. Serial studies of the marrow were done in 12 of the 14 infants, and single specimens were examined in two infants.

No attempt is made to define the etiology or pathogenesis of the anemia of erythroblastosis fetalis. The purpose of this study was to determine the relationship between degree of anemia and normoblastic activity of bone marrow, as ascertained by morphologic techniques.

On the basis of a review of the literature and the experience with this series of infants, true "aregenerative anemia" appears to be a rare occurrence. Indeed, to suggest that the anemia of erythroblastosis is commonly due to a cessation of erythropoiesis seems totally unjustified, because these infants show hyperplasia of the marrow which is analogous to that seen in other compensated hemolytic anemias.

Human and Sturgeon have stated, and the authors agree, that a relative hypoplasia may occur as cell destruction exceeds cell production. This does not necessarily imply marrow failure or an "aregenerative state," but it may indicate that the balance can be in favor of blood destruction and an anemia of some degree is the result. In a previous report, infants after exchange transfusion did show excessive destruction of donor erythrocytes. The rate of destruction of Rh-negative cells in erythroblastosis fetalis was twice that of normal.

Some of the cases reported in the literature as "aregenerative anemia" lack adequate marrow studies and cannot be accepted as well-documented. It should be emphasized that it may be unwise to conjecture about activity of the bone marrow from reticulocyte studies of the peripheral blood alone.

In this series, the percentage of normoblats in the bone marrow was increased in proportion to the degree of anemia.


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 Arch Pediatr Adolesc MedHome page
C. D. Burk, J. J. Malatack, and G. Ramsey
Misleading Rh Phenotype and Severe Prolonged Anemia in Hemolytic Disease of the Newborn
Arch Pediatr Adolesc Med, July 1, 1987; 141(7): 712 - 713.
[Abstract] [PDF]