There is mounting evidence to suggest that T‐cell‐mediated suppression of haemopoiesis is a pathogenetic mechanism in three bone marrow failure syndromes: aplastic anaemia (AA), paroxysmal nocturnal haemoglobinuria (PNH) and myelodysplasia (MDS). T‐cell microclones can be detected by sensitive polymerase chain reaction (PCR)‐based methods in all three disorders. Recently, larger clonal populations of T‐cell large granular lymphocytes (T‐LGLs) have been observed in some patients with AA and MDS. Here, we report the development of a large clonal T‐LGL population in a patient with bona fide PNH. In this patient, we defined part of the sequence of the T‐cell receptor (TCR) β‐chain gene, and we have shown that the large T‐LGL population emerged from a background of multiple smaller T‐cell clones. Thus, T‐LGL clones in AA, MDS and PNH probably expand as a result of antigenic stimulation. It is postulated that the antigen driving clonal T‐cell proliferations in these disorders exists on haemopoietic stem cells.

OBJECTIVES: Our objectives were to (1) expand and strengthen the women's health curriculum at the University of California, San Francisco, and (2) evaluate the responses of both medical students and faculty to this curriculum.STUDY DESIGN: A written evaluation of the curriculum in women's health was completed by both students and faculty. Variables studied included mean scores of cases, the overall course score, and the preferences of medical students for faculty specialty in teaching the small groups.RESULTS: The overall course evaluation score was 7.81 (range 1 to 10). For those students who had both faculty from internal medicine or family medicine and obstetrics and gynecology, there was a strong preference that obstetrician-gynecologists teach the majority of the cases.CONCLUSIONS: The new case-based curriculum in women's health was enthusiastically received by both medical students and faculty.