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Red blood cell production is regulated in part by a specific humoral factor, erythropoietin. 1-5 Although the physiologic properties of this substance have been studied extensively, the relationship of erythropoietin to clinical disease remains speculative. 6-12 This paper reports the results of an assessment of plasma and urine erythropoietin levels in 16 patients with acute or chronic bone marrow failure. In 1 patient serial studies were undertaken during the development of a fortuitous remission, while in another, plasma and urinary erythropoietin levels were compared in simultaneously collected samples. Methods and Material Sixteen patients with marrow failure were studied. Twelve were hospitalized at the St. Louis Veterans Administration Hospital, the remainder at the Barnes and Jewish Hospitals. * In 13 patients the disorder was chronic. The diagnosis in 4 patients was chronic bone marrow failure with erythroid hyperplasia; in 5, chronic bone marrow failure with erythroid hypoplasia; in 1, congenital erythroid hypoplasia

To the Editor. —The association between hyperthyroidism and hematologic abnormalities including thrombocytopenia and hemolytic anemia is well described.1-3We herein report an association between pancytopenia and hyperthyroidism both primary and secondary to excessive exogenous thyroid replacement. Report of a Case. —A 48-year-old woman was admitted to the hospital in 1974 with anemia and generalized weakness. Her medical history included a left ovarian papillary cystadenocarcinoma treated in 1971 with transabdominal hysterectomy and bilateral salpingo-oophorectomy and pelvic irradiation. On physical examination, she had ecchymoses on both lower extremities and enlargement of the right lobe of the thyroid. Laboratory data indicated the following: hemoglobin level, 9.0 g/dL; hematocrit reading, 28%; WBC count, 3,100/cu mm; platelet count, 105,000/cu mm, reticulocyte count, 1.5%; serum iron level, 45 mg/dL; and total iron-binding capacity, 210. Coombs' test was negative. Bone marrow aspiration showed normocellularity with a slightly decreased megakaryocyte level and erythroid hyperplasia. Thyroid function tests

The existence of hemolysis in sickle cell disease has been documented by both indirect and direct methods. The existence of bone-marrow erythroid hyperplasia, reticulocytosis, indirect hyperbilirubinemia, and elevations of plasma hemoglobin and serum lactic acid dehydrogenase values show hemolytic disease. Direct studies of erythrocyte survival, including the Ashby differential agglutination technique as well as isotopic methods have all shown a markedly decreased red blood cell survival in the range of 10 to 30 days mean cell life-span. Data obtained by means of endogenous production of carbon monoxide have shown that the mean rate of heme catabolism is approximately six times normal but varies from 3 to 14 times normal in individual patients. These data document, by a relatively new technique, the consistent presence of a severe hemolytic process in sickle cell anemia.

Di guglielmo first called attention to a condition characterized primarily by neoplastic hyperplasia of erythroblastic tissue. Later on, both acute and chronic forms of this disorder were recognized. In addition, it was noted that usually there was neoplastic myeloid involvement as well. It is generally accepted now to refer to cases of leukemia in which neoplastic erythroid hyperplasia is striking but which usually also demonstrate some neoplastic myeloid involvement as Di Guglielmo's syndrome and to group these with the myeloproliferative disorders. It may and frequently does arise de novo as other acute leukemias or may be found as a sequel to other myeloproliferative diseases. Recently, several reports have appeared describing various chromosomal abnormalities noted in some patients with Di Guglielmo's syndrome. 1-5 As with other acute leukemias, the abnormalities are multiple and vary from patient to patient. However, all these reports cite hypodiploidy as a constant feature. We recently studied