Chronic splenic anæmia and Banti's Disease / by H.D. Rolleston.

  • Rolleston, Humphry Davy, Sir, 1862-1944.
Date:
[1914?]
Catalogue details

Licence: In copyright

Credit: Chronic splenic anæmia and Banti's Disease / by H.D. Rolleston. Source: Wellcome Collection.

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    becomes nearly or quite normal, the real condition may be overlooked in the absence of a differential white count. The Tallowing case at first appeared to be one of lymphocytic leukmmia in an aleukaemic phase, but later it was indistin¬ guishable from splenic anaemia. A male, aged 37, had had a large abdomen since boyhood. In 1911 when otherwise well, he was accidentally found, during an attack of colic apparently caused by damsons, to have an enormous spleen. The blood shewed 3,400,000 reds, 60 per cent, haemoglobin, colour index 1 ; leucocytes 3400, lymphocytes 61'2 per cent., nearly all small, mast cells 4 per cent. In January, 1912, after a long railway journey, he became very ill, and, though there was no evidence, looked as if he had lost a large quantity of blood. He also developed ascites and oedema of the feet. On January 18th, the red blood corpuscles were 788,000, the leucocytes 11,400, polymorphonuclears 9*6, lymphocytes 89 2, large hyaline cells 1 ‘2. On January 31st, the red count was 716,000, haemoglobin 15 per cent., colour index 1, leucocytes 7800, polymorphonuclears 14 per cent., lymphocytes 86 per cent. A week later, the red count was 656,000, haemoglobin 16 per cent., leucocytes 3200, polymorphonuclears 23^2 per cent , lymphocytes 76T per cent. The patient gradually recovered, and after a course of X-rays the spleen diminished and the blood count improved, the proportion of lymphocytes becoming nearly noritial. In portal cirrhosis, the spleen is seldom so large, and the hepatic change so latent as to imitate splenic anaemia. Occa¬ sionally in old, and apparently quiescent, cirrhosis of the liver, the spleen may reach a very large size. I have seen this, which is apparently the converse of Banff’s disease, on one or two occasions ; and, as illustrating this, I may also refer to the case of a man who survived the Talma-Morrison operation for 2\ years with steadily increasing enlargement of the spleen, which after death weighed 48 oz. Nannyn and his followers, indeed, regard latent cirrhosis as the real explanation of splenic anaemia. In the form of biliary cirrhosis, in which splenic precedes hepatic enlargement (metasplenomegalic), there is persistent jaundice, which should distinguish it from splenic anaemia. Chronic obstruction of the splenic vein leads to spleno¬ megaly, recurrent gastric haemorrhages, anaemia with a low colour index, and leucopenia—an exact imitation of splenic anaemia. The splenic vein may be (i) reduced to a fibrous cord ; (ii) represented only by a plexus of veins, as in a case in which haematemesis occurred at intervals of 10 months for 20 years (Langdon Brown8); (iii) thrombosed as the result