The mechanism of the anaemia in rheumatoid arthritis: effects of bone marrow adherent cells and of serum on in-vitro erythropoiesis

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Abstract
Clonal assays for erythroid progenitors (BFU-e [erythropoietic burst-forming units] and CFU-e [eythroid colony-forming units]) were used to study 20 patients with rheumatoid arthritis, 15 of whom had anemia of chronic disease and 5 of whom were hematologically normal. The numbers of bone marrow BFU-e and CFU-e in the anemic patients did not differ significantly from those in normal controls. Macrophages were removed from the bone marrow by a combination of adherence and buoyant density centrifugation over a sucrose gradient and the resulting fractions were cultured alone or together with autologous adherent cells in BFU-e assays. Co-culture with adherent cells significantly increased colony growth in both the controls and in 7 of 8 anemic patients studied. Serum from 14 anemic patients and from 5 non-anemic patients was added to cultures of bone marrow or to control peripheral blood null cells. Anemic serum uniformly either inhibited or failed to stimulate BFU-e growth under these conditions. Serum from non-anemic patients and from 10 healthy controls stimulated BFU-e growth from null cells to an equal degree.