Classification of Anemias.pdf

170 PORTO RICO JOURNAL OF PUBLIC HEALTH AND TROP. ){EDICINE
bring errors, that it cannot be perfect, but is it not better than the
method used by the average practitioner today Y Does it not, after
all, hold its place satisfactorily among all of the usual methods and
processes of thought upon which most of us depend for a "clinical
diagnosis" 7 Our clinical sense, aided by a hint from the laboratory
will generally bring us to a more elaborate examination of blood in the
given case.
Probably most of us will agree that to withhold liver or an extract
thereof in the presence of a true pernicious anemia, and load iron
into a liver already choked with it is reprehensible. Yet, few realize
the frequent hypoplastic forms of pernicious anemia in the
tropics to be a true exhaustion process, in which a continuance of
liver extract will only serve to drain the purse of the poor who need
the money to restore the blood-making organs by proper food. If
after intelligent diet these organs can have their vital elements built
in again by nature, a second trial with liver extract may succeed,
especially if we take into account that back of all, there is an already
impotent liver which needs protection against dietary abuse, and
nourishing food for its own tissues. In a long series of chemical
analyses of the blood in cases of sprue and its anemia of pernicious
type, there is to be seen quite regularly, a very low cholesterol content
and a high icteric index. But time forbids the tabulation of
this data in this paper.
If what may be a pardonable error in insisting upon liver in
hypoplastic anemia can be condoned, what shall we say of the practice
of administering liver extract by routine in secondary anemia
and worst of all, in hemoglobinemia Y Such conditions usually mean
a dissolution of hemoglobin and erythrocytes in circulation, not a
a failure of the hemopoietic organs.
The writer believes that he has never seen a more precise and
more narrowly limited therapeutic agent than liver extract, judging
from the evidence so far produced. Liver extract will practically always
bring about a shower of reticuloeytes and at least an apparent
cure in von Biermer's dysplastic pernicious anemia. In the experience
of most of us, however, it will not bring about this shower
in secondary anemia. It may do so in a blood, temporarily possessing
a low color index, but in one which measurement of erythrocytes
and a wide dispersion i(anisocytosis) show to be essentially a megoblastic
affair. It may have the same effect in a pernicious anemia
blood with a temporary low color index and a microcytosis, but the