Polycythaemia vera: differential diagnosis by ferrokinetic studies and treatment with busulphan (Myleran).

Abstract

Summary. Twenty‐two patients with polycythaemia Vera, six with benign polycythaemia or relative polycythaemia and six with secondary (hypoxaemic) polycythaemia were compared by means of ferrokinetic studies and measurement of bone‐marrow iron stores. In polycythaemia Vera a poor correlation was noted between the haemoglobin (Hb), packed cell volume (PCV) and total red‐cell mass (TRBC). Reliance on the Hb and PCV alone is frequently misleading in the differential diagnosis of the polycythaemic states. A rapid 59Fe T1/2 (< 30 minutes) was found in 85 per cent of patients with polycythaemia Vera, and was associated with absent marrow iron stores in 21 of 22 patients. In benign polycythaemia and relative polycythaemia the 59Fe T1/2 was normal and stainable iron was present in the marrow. Similar findings were noted in secondary polycythaemia.Fifteen of the 22 patients with polycythaemia Vera were treated with busulphan. This treatment was effective in controlling leucocytosis and thrombocytosis. Dosage, toxicity and indications for the use of busulphan in the treatment of polycythaemia Vera are discussed.