A report is presented on two women suffering from severe iron deficiency anemia, concomitant with abnormal hemolysis. The life span of the patients’ red cells was shortened; transfused normal red cells were more rapidly broken down. Extracorpuscular factors seem to be responsible for the pathologic hemolysis. There was no pathologic sequestration of red cells labeled with Cr51 in the spleen.

After incorporation of radioactive iron into the red cells, the utilization percentage of Fe59 under iron therapy fell to about 15 per cent within a few weeks. This, too, indicates that the pathologic hemolysis was to be ascribed to extracorpuscular factors. The Fe59 was apparently not sufficiently reutilized. The constantly decreased serum iron concentration might also indicate a disturbance in the reutilization of iron liberated during red cell breakdown.

Six other patients with less severe iron deficiency anemia and an insufficient response to iron therapy were examined in addition. In 5 of these patients, the life span of red cells labeled with radioactive chromium was found shorter than normal. An insufficient response to iron therapy in patients with chronic iron deficiency anemia may be ascribable, in some instances, to concomitant pathologic hemolysis.

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