Classification of Anemias.pdf

174 PORTO RICO JOURNAL OF P UBLIC H EAIJTH AND TROP. MEDICINE
known error in technique, 'but in a badly dehydrated patient it is
apt to completely ruin a correct estimation. This error is fre quently
made by those whose tim e is limited. It is difficult to explain some
of these abnormally high eryth r ocyte counts. My personal attention
was given to the investigation as I had no intention of being deceived
by poor technique, realizing as I did that a short cut means accuracy
if reliable results arc to be expected. F irst of all, it is
!believed that th e normal five million erythrocytes is too low in the
tropics. The reasonabl e hypothesis in t he caSe of small doses of
poison, whether of mycotic, bacterial or of a chemical nature , (the
latter the result of imperfect elimination of waste products) , is that
these, like all poisons, stimulate before th ey depress. That in the
early and mild anemias of sprue a toxic stimulus to the hemopoietic
organs works in this manner , seems worthy of consideration.
Another observation which can be made is that th e hemoglobin ,
is, at least, only very indirectly affected by liver extract. This can
be seen notably in case 15. H ere persistent use of liver extract
seemed only to increase the erythrocytes, A more poignant question
is: Wh at constitutes hematologically, a pernicious type 'of anemi a '
Certainly not color index alone (see cases 15, 38, 39, and others) .
iNor cell diameters (see cases 24, 25, 26, 27) . The truth is that the
best criterion is the Price-Jones curve. A high mean , a discordant
medi an, and wide dispersion, after all, are the best hematologic evidenc
e. The ti me-honored high color index is not to be despised,
but a reference to case 25 alone, with its vigorous reticulocytosls
after liver extract, will shake our hitherto blind faith in high color
indices as a sine qua non of' pernicious anemia. The real diagnosis
will be made from the sum total of accurate data, clinical and lab o­
r atory, after skillfully weighing all evidence , and this requires
clinical and laboratory knowledge. Even with some facts considered
t o be pathognomonic in the hematology of pernicious anemia:
clinical experience is indispensable for interpretation.
In looking over the ta bulatio n of cases of "secondary anemia" in
this paper, it is inevitable that we should inquire : May not many
of these be merely a. remission in the course of a pernicious typ e of
anemia The writer himself feels confident th at such is the ease,
not for any considerable number, but certainly for some. The avarage
cell diameter in the few in which such diam eters were taken
bespeaks a secondary anemia, but there are elsewhere low values
which may indeed be merely pernicious anemia. remissions.
There are two very striking differences between the pernleious