Clearly, acquired pure erythroid aplasia is a disorder of heterogeneous etiology and pathogenesis. Perhaps the most interesting aspect of PRCA in recent years has been the role of the immune system in its causation. Even here there is pathogenetic heterogeneity. Thus, in PRCA due to humoral immunity, there is heterogeneity with regard to the target at which the antibody is directed, e.g. red cell precursors at various stages, growth factors including erythropoietin, and probably others yet to be identified. It has also become apparent that the cellular immune system may be of central importance. The role of lymphocytes both in promoting and suppressing erythropoiesis is a subject of intense interest. The deciphering of the various lymphocyte subtypes involved and the growth and suppressor factors derived therefrom should greatly enhance our understanding of PRCA and related disorders.
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