Relative Monocytosis in Patients with Erythrocytosis

Hiroshi Fujita, Akira Ohwada, Naoko Handa, Shigeko Nishimura

Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan..
Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.

DOI: 10.4236/ojbd.2013.31005                

Abstract

Polycythemia vera (PV) is characterized by leukocytosis, thrombocytosis, and low mean capsular volume (MCV). No specific hematological findings are observed in patients with erythrocytosis of other origins. However, recombinant erythropoietin (EPO) increases the number of mononuclear cells in the peripheral blood. Therefore, we hematologically examined monocytes in patients with erythrocytosis. The medical records of 48 erythrocytosis patients (hemoglobin: men, >18.5 g/dL; women, >16.5 g/dL) collected between August 2005 and July 2012 were reviewed for age, gender, hematology, and serum erythropoietin level. Patients were divided into 3 groups: PV (N = 17), reactive erythrocytosis (RE, N = 25), and EPO-elevated erythrocytosis (EPO-E, N = 6). We compared monocytes in the hemogram among the 3 groups and examined the correlation between hematological data and serum EPO level. The percent monocytes in the hemogram were 3.4% ± 0.3%, 7.4% ± 0.4%, and 12.3% ± 1.1% for the PV, RE, and EPO-E groups, respectively, which were significant (p < 0.05). Absolute monocyte counts in the EPO-E group (1.0 ± 0.1 × 10⁹/L) were significantly higher than those in the PV (0.6 ± 0.1 × 10⁹/L) and RE (0.5 ± 0.3 × 10⁹/L) groups. There were 2 (12%), 0, and 3 (50%) patients with monocytosis (>1.0 ′ 10⁹/L) in the PV, RE, and EPO-E groups, respectively. A significant correlation was observed between percent monocyte or absolute monocyte count and serum EPO level. In conclusion, monocyte count in hemograms may be useful for diagnosing EPO-elevated erythrocytosis.

Keywords

Erythropoietin; Monocyte; Erythrocytosis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. W. Vardiman, J. Thiele, D. A. Arber, R. D. Brunning, M. J. Borowitz, A. Porwit, N. L. Harris, M. M. Le Beau, E. Hellstrom-Lindberg, A. Tefferi and C. D. Bloomfield, “The 2008 Revision of the World Health Organization (WHO) Classification of Myeloid Neoplasms and Acute Leukemia: Rationale and Important Changes,” Blood, Vol. 114, No. 5, 2009, pp. 937-951. doi:10.1182/blood-2009-03-209262
[2]	T. Barbui, A. Carobbio, A. Rambaldi and G. Finazzi, “Perspectives on Thrombosis in Essential Thrombocythemia and Polycythemia Vera: Is Leukocytosis a Causative Factor?” Blood, Vol. 114, No. 4, 2009, pp. 759-763.
[3]	H. Fujita, S. Kurosawa, S. Nishimura, J. Tomiyama, T. Hamaki and A. Ohwada, “Significance of Microcytosis in the Clinical Course of Erythrocytosis,” Internet Journal of Geriatrics and Gerontology, Vol. 6, No. 1, 2010, pp. 1-4. doi:10.5580/e0b
[4]	H. Fujita, R. Sakuma, J. Tomiyama, T. Hamaki, A. Ohwada, and S. Nishimura, “Relationship between Clotting Activity and Phosphatidylserine Expression on Erythrocyte Membranes in Polycythemia Vera Patients with the JAK2 V617F Mutation,” Archives of Physiology Biochemistry, Vol. 117, No. 4, 2011, pp. 231-235. doi:10.3109/13813455.2011.571262
[5]	H. Fujita, T. Hamaki, N. Handa, A. Ohwada, J. Tomiyama and S. Nishimura, “Hypocholesterolemia in Patients with Polycythemia Vera,” Journal of Clinical Experimental Hematopathology, Vol. 52, No. 2, 2012, pp. 85-89. doi:10.3960/jslrt.52.85
[6]	H. Fujita, T. Hamaki, A. Ohwada, J. Tomiyama and S. Nishimura, “Serum Levels of Granulocyte Colony-stimulating Factor in JAK2 V617F-Positive vs. Negative Erythrocytosis,” International Journal of Laboratory and Hematology, Vol. 33, No. 6, 2011, pp. e20-e21. doi:10.1111/j.1751-553X.2011.01336.x
[7]	C. Heeschen, A. Aicher, R. Lehmann, M. Vasa, C. Urbich, C. Mildner-Rihm, H. Martin, A. M. Zeiher and S. Dimmeler, “Erythropoietin Is a Potent Physiologic Stimulus for Endothelial Progenitor Cell Mobilization,” Blood, Vol. 102, No. 4, 2004, pp. 1340-1346. doi:10.1182/blood-2003-01-0223
[8]	A. V. R. Santhanam, L. V. d’Uscio, T. E. Peterson and Z. S. Katuzic, “Activation of Endothelial Nitric Oxide Synthase Is Critical for Erythropoietin-Induced Mobilization of Progenitor Cells,” Peptides, Vol. 29, No. 8, 2008, pp. 1451-1455. doi:10.1016/j.peptides.2008.03.016
[9]	K. A. Lisowska, A. Debska-Slizien, E. Bryl, B. Rutkowski and J. M. Witkowski, “Erythropoietin Receptor is Expressed on Human Peripheral Blood T and B Lymphocytes and Monocytes and Is Modulated by Recombinant Human Erythropoietin Treatment,” Artificial Organs, Vol. 34, No. 8, 2010, pp. 654-662.
[10]	A. Desai, Y. Zhao, H. A. Lankford and J. S. Warren, “Nitric Oxide Suppresses EPO-Induced Monocyte Chemoattractant Protein-1 in Endothelial Cells: Implications for Atherogenesis in Chronic Renal Disease,” Laboratory Investigation, Vol. 86, No. 4, 2006, pp. 369-379. doi:10.1038/labinvest.3700396
[11]	C. D. Gerharz, P. Reinecke, E. M. Schneider, M. Schmitz and H. E. Gabbert, “Secretion of GM-CSF and M-CSF by Human Renal Cell Carcinomas of Different Histologic Types,” Urology, Vol. 58, No. 5, 2001, pp. 821-827. doi:10.1016/S0090-4295(01)01371-1
[12]	S. W. Mamus, S. Beck-Schroeder and E. D. Zanjani, “Suppression of Normal Human Erythropoiesis by Gamma Interferon in Vitro,” The Journal of Clinical Investigation, Vol. 75, No. 5, 1985, pp. 1496-1503. doi:10.1172/JCI111853
[13]	J. J. Rinehart, E. D. Zanjani, B. Nomdedeu and B. J. Gormus, “Cell-Cell Interaction in Erythropoiesis,” The Journal of Clinical Investigation, Vol. 62, No. 11, 1978, pp. 979-986. doi:10.1172/JCI109227