Felty's syndrome originally was chronic rheumatoid arthritis, splenomegaly, and granulocytopenia. Other attributes have since come to be associated with it. Mild or moderate anemia and thrombocytopenia persist in most patients. A hypercellular marrow usually indicates that the low cell counts in the blood are provoking increased production. Of more serious concern is the ofttimes association of serious infection and sometimes indolent ulcers of the legs, buttocks, mouth, and even of the cornea.
The combination of granulocytopenia and infection has evoked a natural assumption of cause and effect, but the assumption may not be valid. Although the leukocyte counts are low, plenty of "polys" reach the places where they are needed. An important factor in evaluating clinical importance of any granulocytopenia is the presence of polys outside the blood.1 To look for them make a smear of nasal secretions. In Felty's syndrome the polys are there, outside the blood. The
Crosby WH. What to Treat in Felty's Syndrome. JAMA. 1973;225(9):1114-1115. doi:10.1001/jama.1973.03220370052017