[Pure red-cell aplasia accompanied by neutropenia with increased granular lymphocytes--different effects of prednisolone and cyclophosphamide on improving anemia and neutropenia].

Our report concerns a 53 year-old woman with pure red-cell aplasia (PRCA) accompanied by neutropenia. In July 1992, she experienced palpitations and came to our hospital. A peripheral blood examination demonstrated severe anemia and neutropenia, and an analysis of bone marrow cells revealed a marked decrease in the erythroid series. She was therefore diagnosed as PRCA. Sixteen percent of her peripheral lymphocytes had azur granules, which were considered to be a T-cell lineage based on surface marker analysis. However, gene analysis of T-cell receptors indicated no clonality. Administration of prednisolone (PSL) improved the subject's neutropenia but not her anemia. However, administration of cyclophosphamide (CPM) was effective in reducing the granular lymphocyte count, and finally improved the anemia. In this case, the granular lymphocytes presumably participated in the pathogenesis of anemia and neutropenia. While PSL did not yield sufficient effects on anemia and neutropenia, CPM was effective, suggesting that each drug may have different effects on these disorders.