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July 20, 1940


JAMA. 1940;115(3):235. doi:10.1001/jama.1940.02810290065028

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To the Editor:—  The excellent article by Seidler and Brakeley on "Gallstones in Children" (The Journal, May 25, p. 2082) fails to mention, in consideration of etiology, the importance of hemolytic anemia. The bouts of excessive bilirubinemia and pigment excretion characteristic of certain cases of congenital hemolytic ictero-anemia and of sickle cell anemia seem to predispose to early gallstone formation. In the past few years I have seen two examples of each condition in patients under 15 years of age. The following synopsis of the history of a recent case will serve to illustrate the point:A lad of 14 was referred because the family physician was unwilling to accept the diagnosis and hopeless prognosis, given elsewhere, of "terminal juvenile biliary cirrhosis." Examination disclosed deep jaundice, mahogany colored urine, fever, a mass in the liver area, splenomegaly, dehydration, purpura and ominous drowsiness. The boy had been "sickly" for five or

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