(MYELOID LEUCEMIA; MYELEMIA)
Myelemia is a disease characterized by an enormous increase in the
white cell content with proportionate changes in the spleen, liver, and
the blood marrow.
=Etiology.=—It is a disease occurring at all ages, but the majority of
cases are recognized in adult males.
Heredity, trauma to the spleen, malaria, syphilis, and rapid repetition
of pregnancies seem to be at least exciting factors. A few cases have
been reported in which tenth, eleventh, and twelfth rib lesions were
definite etiologic factors by pressure.
=Diagnosis.=—The patient goes through a period of vague, indefinite,
and wandering symptoms. General malaise, weakness often accompanied by
dyspnea, and emaciation similar in many ways to incipient pulmonary
tuberculosis, except that the slight temperature changes are not
typical. At the same time there may be digestive discomfort of
various kinds without typical pathology. Of these early symptoms the
most persistent is the =dyspnea= which is a structural result of the
increase in size of the spleen. As a direct pressure result of this
hyperplasia, there may develop dropsical infiltration of the lower
extremities and ascitic accumulation in the abdominal cavity.
With the changes in the blood itself, the blood vessel walls break down
more easily, and subcutaneous hemorrhages, epistaxis and hematemesis
are common.
In an attempt to destroy the excessive amount of white cells, the liver
may become enlarged. But this occurs later and of much less degree
than the enormous increase in size of spleen. There may be areas of
hemorrhage with resulting softening in the spinal cord. The most likely
areas to suffer are the posterior and lateral horns, with resulting
paraplegia, spastic or ataxic.
Usually, the course is slow, and the condition is truly chronic. But,
occasionally, the rapid increase and succession of symptoms, with
concomitant blood changes, change the diagnosis to acute myelogenous
leukemia.
The total cell count, red plus white, is diminished, for while there is
enormous relative increase of the white cells a greater actual decrease
takes place in the reds. This decrease in reds is partially relative
from crowding out of erythrocytes by leucocytes, but there is also
actual decrease in their formation, so that there is an actual anemia
present as well as a leukemia.
In some respects the red cells behave as in chlorosis, each carrying
a diminished percentage of hemoglobin, resulting in a low color
index. Atypical staining reactions and morphology, together with many
fractured forms, are the rule. Normoblasts are common throughout the
course of the disease, but megaloblasts seldom appear until near fatal
termination.
The changes in the white cells are enormous, both as to numbers and
character of cells found. The total white count often exceeds 350,000.
This, with the accompanying reduction in number of erythrocytes,
leads to a reduction of the ratio between reds and whites to as low
as 1 to 5 or 3, or occasionally 1 to 1. There is an actual increase
in number of all the white cells with the possible exception of the
lymphocytes. In the actual increase of polymorphonuclear neutrophiles
and eosinophiles is rendered a sharp relative decrease by the enormous
production of myelocytes. Basophiles are usually both relatively and
absolutely increased. In a white count of 350,000 it is not unusual to
have present 325,000 myelocytes, with 25,000 as the actual number of
ordinary leucocytes. There is, therefore, a =mild leucocytosis= coupled
with a =violent= leukemia. These two are combined with an =anemia= that
varies with the course of the disease.
=Treatment.=—The treatment is largely hygienic, including thorough
osteopathic attention to the lower dorsal and costal area. Symptomatic
treatment is often followed by temporary improvement both clinically
and in the blood picture, but complete recovery seldom takes place.
Occasionally, roentgen therapy has given a “cure” lasting several years.
=Prognosis= is not good. These patients are frequently carried away
quickly by some oftentimes slight intercurrent infection. Even if
carefully guarded from such, the course of the process usually leads to
death from exhaustion in two or three years.