Volume 2

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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    Serology. The antiglobulin test was positive and the reaction appeared to be of the non-y type. Cold agglutinins were present only to a titre of 8 at 2° C. The indirect antiglobulin test was negative but trypsinized cells revealed the presence of a low-titre antibody active at 37° C. which was not identified. Further Progress and Treatment (Fig. 144). Splenectomy was carried out on May 12th, 1954. This was followed by a rise in leucocyte count to 20,000 per cu. mm. the day after operation. Convalescence was com- plicated by a subphrenic abscess but this was successfully dealt with by antibiotics and drainage. The leucocyte count was sustained within the range 5,000-10,000 per cu. mm. for 6 months following the operation but in November 1954 a count of 3,500 per cu. mm. was recorded. The hemoglobin had by then reached 12-7 g. per 100 ml., with 2-:2% reticulocytes; the serum bilirubin was 0-5 mg. per 100 ml. When last seen on January 138th, 1955, 8 months after splenectomy, the hzemo- globin was 11-4 g. per 100 ml., reticulocytes 5-2%, total leucocytes 7,000 per cu. mm. and platelets 510,000 per cu. mm. The antiglobulin test was still positive. The spleen weighed 1,475 g. and its pulp was red and congested. The Malpighian bodies were unduly prominent and easily visible to the naked eye and in places appeared to coalesce. Sections of the spleen showed that the normal architecture was preserved. The sinuses were largely empty of blood but the Billroth cords were engorged and the littoral cells were hyperplastic. The Malpighian corpuscles were en- larged but were normal in structure. There was some siderosis, but erythropoiesis was not conspicuous. The conclusion was that the spleen had undergone simple hyperplasia. Lymph nodes removed with the spleen had a normal architecture but there was evidence of much erythrophagocytosis and siderosis. Summary. A case of “idiopathic” auto-immune hemolytic anzemia of the warm-antibody type associated with leucopenia and massive splenomegaly. Improvement followed splenectomy. REFERENCES ANDRE, R., Dreyrus, B., SALMON, C., and MALASSENET, R. (1955). **Hemoglobinurie et acrocyanose paroxystiques avec agglutinines froides a un titre trés élevé.”? Bull. Soc. méd. Hop. Paris, 71, 146. Baikig, A. G., and Pirrie, R. (1956). “‘ Megaloblastic erythropoiesis in idiopathic acquired hemolytic anemia.’’ Scot. med. J., 1, 330. BAKKER-V. AARDENNE, W. I. T., VerRLoop, M. C., and BorrzELAER, G. C. D. VAN (1958). ‘Osmotic and mechanical fragility of erythro- cytes in patients with idiopathic and symptomatic hemolytic anemia.’ Proc. 6th Congr. Europ. Soc. Hematol., Copenhagen, 1957, p. 695. Karger, Basel. BatTEMAN, J. C. (1949). ‘“‘Symptoms attributable to cold hemagglutina- tion.”? Arch. intern. Med., 84, 523. BAUMGARTNER, W. (1948). ‘Kalteagglutinine und periphere Zirkula- tionsstorungen.”’ Helv. med. Acta, 15, 411. BAUMGARTNER, W. (1952). ‘“‘Zur Klinik der serologisch bedingten hamolytischen Andmie.”’ Helv. med. Acta, 19, 71.