The case of a patient with chronic neutropenia without splenomegaly, but responding favorably to splenectomy is reported. The surgical procedure appeared to be indicated by the following: (1) exclusion of the extrinsic causes of neutropenia; (2) failure of response to the agents commonly employed to stimulate granulopoiesis; (3) demonstration of granulopoiesis in the sternal marrow; (4) increase in the circulating neutrophils following the parenteral administration of epinephrine; (5) the presence of coexisting diabetes with the potential hazard of infection.
The implication of the spleen as the main factor in the causation of the neutropenia in this case seems well established, although the specific mechanism is not apparent. There was no evidence of abnormal phagocytosis in the microscopic examination of the spleen.
ACKNOWLEDGMENT We wish to express appreciation to Captain Earl F. Evans, Medical Corps, U. S. Navy, for his assistance in the management of this case.