Edward Campbell, MD, Assistant in Medicine, Department of Medicine, Jewish Hospital of St Louis, Washington University School of Medicine. A 77-year-old woman was admitted in February 1976 for evaluation of persistent hemolytic anemia and granulocytopenia. According to the patient and her physician she had had splenomegaly for more than 40 years, although the exact cause for splenic enlargement was never adequately ascertained. There was no history of anemia or granulocytopenia prior to August 1974. One year prior to this admission, the patient was admitted to the Jewish Hospital with a three-week history of weakness and easy fatigability following an insect bite on her finger. At that time she developed a local abscess, which was treated with incision and drainage and tetracycline. Following the institution of tetracycline therapy, she experienced an episode of gross hematuria. A "urinary tract infection" was diagnosed, the tetracycline discontinued, and orally given carbenicillin therapy was instituted.
Chaplin H, Avioli LV. Autoimmune Hemolytic Anemia. Arch Intern Med. 1977;137(3):346-351. doi:10.1001/archinte.1977.03630150048014