Volume 3

The haemolytic anaemias, congenital and acquired / by J.V. Dacie.

  • Dacie, John V. (John Vivian), Sir.
Date:
1960-1967
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: The haemolytic anaemias, congenital and acquired / by J.V. Dacie. Source: Wellcome Collection.

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    The day following admission she developed signs of deep vein throm- bosis in the left leg and she also complained of central chest pain. An ECG (and a striking rise in serum lactic dehydrogenase) confirmed the diagnosis of myocardial infarction. Anticoagulant therapy was com- menced, and the oedema responded to diuretic therapy. ‘Subsequently, the blood picture improved strikingly (Fig. 181), the hemoglobin reaching a peak value of 14-8 g. per 100 ml. 25 days after admission. The ACTH and prednisone were in due course stopped and reduced to 12:5 mg. daily, respectively. However, within 2-3 Haemoglobin (g/100mt.) “VA Reticulocyt (°/o) ; Platelets (cu.mm.] *._ Leucocytes (cumm.) _-*# » ? = a we, , B---e-~ Fic. 181. Hematological changes in a patient suffer- ing from Hodgkin’s disease and auto-immune hemo- lytic anemia (Case 14). Response to ACTH and SW; Bi BO Md, Be eee, tee eee 1964 NOVEMBER DECEMBER T= transfusions. weeks severe hemolysis recurred which could not be controlled by the use of ACTH and prednisone. Chest pain, attributed to pulmonary emboli, also developed. She died on the 24th December 1964. Post-mortem examination showed the signs of severe anzemia, deep vein thrombosis in both legs, pulmonary embolism and the presence of deposits of Hodgkin’s disease, particularly in abdominal lymph nodes. Sections of these nodes showed that the tumour had become transformed into a pleomorphic reticulosarcoma (Hodgkin’s sarcoma). Summary. A case of Hodgkin’s disease presenting as an auto-immune hemolytic anzmia of warm-antibody type. The diagnosis was made from a lymph-node biopsy taken at the time of splenectomy. Death was due to pulmonary embolism and uncontrolled anzemia.