In 1915 a man aged 40 (J. L.) with severe hemolytic anemia was studied by us in the Hospital of the University of Pennsylvania. His presenting symptoms were weakness, dizziness, dyspnea and edema, which had been increasing for two years. The metabolism studies, before and after splenectomy, which were reported in 1916,1 revealed that soon after splenectomy there occurred a retention of nitrogen, a decrease in the output of uric acid and iron and a pronounced decrease in the definitely elevated excretion of urobilinogen and urobilin.
On admission in 1915 the patient's blood counts showed a hemoglobin varying from 20 to 26 per cent, a red count between 1,100,000 and 1,700,000 per cubic millimeter, a low white cell count and, in addition, all the morphologic picture which in those days established the diagnosis of pernicious anemia; there were many normoblasts and typical megaloblasts. The coagulation time was normal, as
Pepper OHP, Austin JH. A TWENTY-EIGHT YEAR FOLLOW-UP ON A SPLENECTOMY FOR HEMOLYTIC ANEMIA: PERSISTENCE OF HOWELL-JOLLY BODIES. JAMA. 1943;122(13):870–871. doi:10.1001/jama.1943.72840300001008
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