Casadevall N, Lacombe C, Varet B
Service d'Hématologie, INSERM U152, Hôpital Cochin, Paris, France.
Nouv Rev Fr Hematol (1978). 1990;32(1):77-81.
In vitro cultures of erythroid progenitors and radioimmunoassay of erythropoietin (Epo) are 2 recently available techniques. It is possible to assess their relevance in various hematological disorders. Erythroid cultures can be performed in the investigation of polycythemias, pure red cell aplasias (PRCA) and refractory anemias. In primary polycythemias "spontaneous" colonies appear in vitro whereas this phenomenon is never observed in secondary polycythemias. These so called "spontaneous" colonies have been demonstrated with a lower incidence in all myeloproliferative disorders. Therefore, if the absence of spontaneous colonies does not permit us to eliminate the presence of a myeloproliferative syndrome aside from polycythemia vera, their presence does seem pathognomonic of a myeloproliferative disorder. In acquired chronic pure red cell aplasia in adults, a strong correlation is found between the in vitro growth of erythroid colonies and the results of immuno-suppressive treatment. In refractory anemias erythroid cultures do not have either diagnostic, or prognostic interest. Serum epo level does not have a high discriminatory value in distinguishing between primary and secondary erythrocytosis. Indeed in PV, the Epo level is generally low or normal, in secondary polycythemias Epo level is high or normal. There is an important overlap between the two groups. Epo level determination can have a therapeutic incidence. Administration of recombinant Epo seems justified only in patients both sufficiently anemic to warrant transfusions and in whom Epo level is low in comparison with the degree of anemia.
红细胞祖细胞的体外培养和促红细胞生成素（Epo）的放射免疫测定是最近可用的两种技术。评估它们在各种血液系统疾病中的相关性是可能的。红细胞培养可用于真性红细胞增多症、纯红细胞再生障碍性贫血（PRCA）和难治性贫血的研究。在原发性真性红细胞增多症中，“自发”集落可在体外出现，而继发性真性红细胞增多症中从未观察到这种现象。这些所谓的“自发”集落在所有骨髓增殖性疾病中的发生率较低。因此，如果自发集落的缺乏不能使我们排除除真性红细胞增多症外骨髓增殖综合征的存在，那么它们的存在似乎确实是骨髓增殖性疾病的特征性表现。在成人获得性慢性纯红细胞再生障碍性贫血中，红细胞集落的体外生长与免疫抑制治疗的结果之间存在很强的相关性。在难治性贫血中，红细胞培养既没有诊断价值，也没有预后价值。血清Epo水平在区分原发性和继发性红细胞增多症方面没有很高的鉴别价值。事实上，在真性红细胞增多症中，Epo水平通常较低或正常，在继发性真性红细胞增多症中，Epo水平较高或正常。两组之间有重要的重叠。Epo水平测定可能具有治疗意义。仅在贫血严重到需要输血且Epo水平与贫血程度相比很低的患者中，给予重组Epo似乎是合理的。
