The history and course of a middle-aged woman with a chronic acquired hemolytic anemia have been presented. Splenectomy resulted in a complete remission of the disease for 18 months before a relapse occurred which led eventually to a fatal termination.
The original cause of the abnormal hemolytic process is not known, but the onset of the relapse was closely associated with the resumption of gold therapy.
The acceleration of the hemolytic process was associated with an increasing tendency toward spherocytosis and susceptibility of the erythrocytes to hemolysis in hypotonic solution.
It is demonstrated that transfused normal erythrocytes shared in the hemolytic process and were eliminated from the circulation at an abnormal rate although no atypical isohemolysin was demonstrated by in vitro tests.
An attempt was made to alter the rate of hemolysis in several ways. The injection of thorium dioxide was followed by signs of transitory slowing of red cell destruction. Injections of Congo red were apparently without effect. Irradiation of the mediastinal and periaortic nodes was begun to ascertain if the production of a hemolytic antibody in lymphatic tissue could be altered. Irradiation was followed by a fall in leukocyte and lymphocyte counts in the peripheral blood. Transfusions were then followed by partial remissions in the hemolytic process for varying periods of time in two instances. Irradiation of a second patient with a chronic hemolytic anemia of similar character produced a fall in leukocyte count and lymphocyte count, but in the absence of transfusions no slowing of the hemolytic process occurred.
No definite conclusions can be drawn from these fragmentary observations on the effect of irradiation, but further investigation as to the character of the hemolytic substance and possible methods of modifying its production are indicated when the opportunity is afforded.