Classification of Anemias.pdf
Classification of Anemias.pdf 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
SUGGESTIONS FOR A RAPID CLA~SIFICATION OF THE AN E)!lAS, ETC. 171 Price-Jones curve, properly made will easily disclose the nature of such " secondary" anemias, A t rue aplasia of the bone marrow was found at autopsy in One of my cases of pernicious anemia due to sprue and not responding to l!ver extract by Professor R. A. Lambert of this School two years ago, and section of bone marrow by biopsy in a series of such eases now being made by others will demonstrate, I believe, that aplasia and hypoplasia is the rule in these clinical types. It i hoped that liver extract may be an efficient reducer of high blood pressure but that thi s is a scientific fact is not yet sufficiently demonst rated to bring about a doctrinal acceptance. It is not denied that the present belief in a potent hormone on the part of th e lay pu blic, who attrib ute to it a dominant power to overcome all anemias, as well as many strange influences on other organs and their f unctions, may not some day prove to be in some indirect measure justified, but the practicable, un questiona ble fact confronting us now is that no sufficient evidence has been produced to show that such effects are due to liver. F acts in Medicine are not commonly proven alone hy one man ' 8 flzures but by those of many r eputable investigators. Working on th e clinical plan set forth, the 209 cases in which the condition of blood in sprue an d digestive incompetence was investigated yield thc following r esults : CASES L'( wmcn ON LY THE HEMOGLOB IN WAS INVESTIGATED Normal H emoglobin (90-100 plus per cent). Total nutnber of cascs ' 14 Avera ge Hemoglobin perccntage 98.3 Cases of sp rue (3 severe, 4 moderate)_ ______________________________ 7 Average hemoglobin perc entage 102.3 Digest ive incompet ence (t he syndrome of th e prevalent nut ritional unbalan ce of t his Islan d) 7 Aver ag e hemoglobin 94. 4 Calle. wit h a hcmoglob in perc cntage Total nu mber of such cascs Aver ag o hemoglobin perc ent age Cases of spruc belOID 90. 74.8 Average hemoglobi n 74. 8 Digestive incompet cnee.,, __ __ ___ ____ __ 50 Average hemoglobin ~ H .8 Loss of weight in the above cases: Average of 29 cases of spru e 26. 5 pounda Aver age of 38 cases of digcstive incompetence 17.5 " 84 34
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SUGGESTIONS FOR A RAPID CLA~SIFICATION OF THE AN E)!lAS, ETC. 171<br />
Price-Jones curve, properly made will easily disclose the nature <strong>of</strong><br />
such " secondary" anemias, A t rue aplasia <strong>of</strong> the bone marrow was<br />
found at autopsy in One <strong>of</strong> my cases <strong>of</strong> pernicious anemia due to<br />
sprue and not responding to l!ver extract by Pr<strong>of</strong>essor R. A. Lambert<br />
<strong>of</strong> this School two years ago, and section <strong>of</strong> bone marrow by biopsy<br />
in a series <strong>of</strong> such eases now being made by others will demonstrate,<br />
I believe, that aplasia and hypoplasia is the rule in these clinical<br />
types.<br />
It i hoped that liver extract may be an efficient reducer <strong>of</strong><br />
high blood pressure but that thi s is a scientific fact is not yet sufficiently<br />
demonst rated to bring about a doctrinal acceptance. It is<br />
not denied that the present belief in a potent hormone on the part<br />
<strong>of</strong> th e lay pu blic, who attrib ute to it a dominant power to overcome<br />
all anemias, as well as many strange influences on other organs and<br />
their f unctions, may not some day prove to be in some indirect<br />
measure justified, but the practicable, un questiona ble fact confronting<br />
us now is that no sufficient evidence has been produced to show<br />
that such effects are due to liver. F acts in Medicine are not commonly<br />
proven alone hy one man ' 8 flzures but by those <strong>of</strong> many<br />
r eputable investigators.<br />
Working on th e clinical plan set forth, the 209 cases in which the<br />
condition <strong>of</strong> blood in sprue an d digestive incompetence was investigated<br />
yield thc following r esults :<br />
CASES L'(<br />
wmcn ON LY THE HEMOGLOB IN WAS INVESTIGATED<br />
Normal H emoglobin (90-100 plus per cent).<br />
Total nutnber <strong>of</strong> cascs ' 14<br />
Avera ge Hemoglobin perccntage 98.3<br />
Cases <strong>of</strong> sp rue (3 severe, 4 moderate)_ ______________________________ 7<br />
Average hemoglobin perc entage 102.3<br />
Digest ive incompet ence (t he syndrome <strong>of</strong> th e prevalent nut ritional unbalan<br />
ce <strong>of</strong> t his Islan d) 7<br />
Aver ag e hemoglobin 94. 4<br />
Calle. wit h a hcmoglob in perc cntage<br />
Total nu mber <strong>of</strong> such cascs<br />
Aver ag o hemoglobin perc ent age<br />
Cases <strong>of</strong> spruc<br />
belOID 90.<br />
74.8<br />
Average hemoglobi n 74. 8<br />
Digestive incompet cnee.,, __ __ ___ ____ __ 50<br />
Average hemoglobin ~ H .8<br />
Loss <strong>of</strong> weight in the above cases:<br />
Average <strong>of</strong> 29 cases <strong>of</strong> spru e<br />
26. 5 pounda<br />
Aver age <strong>of</strong> 38 cases <strong>of</strong> digcstive incompetence 17.5 "<br />
84<br />
34
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