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To the Editor:
—I was much interested in reading the article by McCord on "The Present Status of Benzene Poisoning" in The Journal, July 27. In the author's discussion of agranulocytosis, he states that "hemorrhage is an almost invariable concomitant" and that "purpura hemorrhagica is present in the greater number of instances." I think this is a misstatement.I have failed to observe hemorrhage in five cases of agranulocytosis seen recently, nor have I seen much reference to it in the literature. The platelets in agranulocytosis are not decreased except in the rare case lasting more than two weeks and hemorrhage does not therefore occur.The author corroborates this statement himself when he writes that in agranulocytosis the coagulation and bleeding times are likely to remain unchanged. The chief differential point hematologically between agranulocytosis and benzene poisoning is that benzene destroys the entire bone marrow, causing a marked anemia (hyperchromic
William Dameshek. BENZENE POISONING AND AGRANULOCYTOSIS. JAMA. 1929;93(9):712. doi:10.1001/jama.1929.02710090052030