Critical review : polycythaemia, erythrocytosis and erythraemia.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Critical review : polycythaemia, erythrocytosis and erythraemia. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The excessive formation of red blood-corpuscles in myelopathic poly- cythaemia may perhaps, as has already been mentioned, be regarded as analogous to the excessive formation of white blood-corpuscles in cases of leukaemia. It can likewise be explained as the result of a morphological and functional reversion to (or, in certain cases, persistence of) a past condition (normal in foetal life and early life after birth) in which the bone-marrow of the shafts of the long bones is red and still actively engaged in the formation of erythrocytes, instead of being yellow and fatty as most of it is in healthy adults. If the analogy to leukaemia proves to be appropriate, the term ‘ erythraemia * must be considered preferable to the term ‘ myelopathic polycythaemia ’ and the various other names which have been proposed, since it implies that the disease is one which in regard to erythrocyte-formation is analogous to leukaemia in regard to leucocyte-formation. In ' fact, if, as H. Ribbert believes, there is a form of ‘ myeloma ’ (that is to say of growth originating in the elements of the bone- marrow) which should be termed ‘erythroblastoma’, because the tumour-cells are related to erythroblasts, it seems possible that cases of erythraemia may bear a relation to cases of erythroblastoma similar to that which cases of leukaemia bear to cases of leucoblastic myeloma. It must, however, be remembered that Ribbert’s case of ‘ erythroblastoma ’ is as yet the only one recorded and the existence of so remarkable a kind of tumour-formation certainly needs confirmation. Objections to the view that the excessive formation of red cells in the bone-marrow is the primary pathological condition in erythraemia have been urged by F. Lommel, J. Bence and others; and it must be admitted that in several cases of clinically (that is presenting the clinical symptom-complex of) splenomegalic polycythaemia evidence of general or local blood-stasis (impeded circulation) has been ascertained, suggesting that the polycythaemia, at all events in the cases in question, was more or less reactive in nature and secondary to imperfect oxygenation in the whole or part of the body. According to Bence, the polycythaemia of splenomegalic polycythaemia can be diminished by oxygen-inhalation, just as he claims that the polycythaemia of cardiac origin and that due to high altitudes can be, but R. Stern and others obtained negative results by this method. I shall return to these subjects in the later portion of this article devoted to erythraemia. Characters of the Blood and Blood-forming Tissues in absolute Polycythaemia. Before proceeding further it will be well to consider certain features common to erythraemia and erythrocytosis. We have already given our reasons for believing that in all cases the essential change in the blood-forming tissues is an increase in the erythroblastic elements of the bone-marrow. We have now to consider certain characters of the blood probably common to all classes of absolute polycythaemia.