A New Diagnostic Test for Acute Disseminated Lupus Erythematosus*

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THE value of the bone marrow examination as a diagnostic aid in acute disseminated lupus erythematosus has been previously reported.1 Subsequent experience has confirmed the worth of this procedure, but difficulties have been encountered in patients with hypoplastic marrows, and in patients who are considered too sick for even the relatively minor trauma of a sternal puncture. It therefore seems appropriate to report a new diagnostic method, utilizing only the plasma of the patient acutely ill with suspected lupus erythematosus, and the cellular bone marrow of normal persons.

As originally noted by Hargraves, Richmond and Morton,2 the striking feature of the bone marrow in acute disseminated L.E. is the L.E. cell, usually a polymorphonuclear leukocyte which has engulfed a large homogenized smoky blue material. In addition, polymorphonuclear leukocytes are occasionally seen clustered around masses of bluish staining material, forming “rosettes.” These two observations have been considered as essentially the same phenomenon, with the L.E. cell as the end result (fig. 1a and b).

In a preliminary paper,3 we reported the induction of the L.E. cell and clumping of polymorphonuclear leukocytes in normal bone marrow preparations by the simple addition of plasma from patients with acute disseminated lupus erythematosus. The phenomenon so induced was indistinguishable from those noticed in L.E. bone marrow preparations. Follow-up studies have emphasized the consistency of this response. This procedure has proved its value as a diagnostic test and as an indicator of severity of infection.


Plasma from a suspected case of acute disseminated lupus erythematosus. . .



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