File:The spleen and anæmia; experimental and clinical studies (1918) (14576859730).jpg

Identifier: spleenanmiaexper00pear (find matches)
Title: The spleen and anæmia; experimental and clinical studies
Year: 1918 (1910s)
Authors: Pearce, Richard Mills, 1874-1930 Krumbhaar, E. B. (Edward Bell), 1882-1966 Frazier, Charles H. (Charles Harrison), 1870-1936
Subjects: Spleen Anemia
Publisher: Philadelphia and London, J. B. Lippincott company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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hree periods. In the firstor pre-ascitic period, usually lasting several years, a grad-ually increasing weakness and pallor is noticed, with diges-tive disturbances and abdominal pain, which may first callattention to the enlarged, smooth, hard spleen. A ten-dency to hemorrhages with a moderate anaemia of chlo-rotic type is usually present, but may be postponed untilthe later stages. There is nothing specially characteristicof the anaemia, the increase of urobilin being the mostsignificant sign of increased blood destruction. The resist-ance of the red cells is unchanged; signs of a regeneratingbone-marrow, as nucleated and reticulated red cells, areslight or absent. After splenectomy, however, an increasedresistance of the cells may be noted, and may be marked.* * In a case I recently examined after splenectomy complete haemo-lysis did not occur in salt solution as low as 0.25 per cent. No nucleatedred cells were found, but reticulated forms were more numerous thanbefore splenectomy.
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TYPES OF SPLENOMEGALY 249 A slight or moderate amount of leukopenia is char-acteristic. The second, or intermediate, stage lasts but a fewmonths, and is characterized by scanty, high-colored urinecontaining an excess of urobilin, by attacks of dyspepsiaand diarrhoea, and by slight increase in the size of theliver. The third stage is ushered in by the symptoms of cir-rhosis, a recurrent, painless ascites, occasionally slightjaundice, shrunken liver, and increasing anaemia and ema-ciation. After a few years an intercurrent infection orfatal hemorrhage is the terminal event. It is hardly neces-sary to say that such a picture is subject to variation,and that in some cases the three periods cannot be dis-tinguished. The first and second of these periods areusually considered as splenic anaemia. Etiology and Pathogenesis.—In spite of the greatamount of work done on Bantis disease in the past twentyyears, not only is its etiology undetermined, but it is stillan open question whether it is

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