A 47-year-old chemical worker was first seen in consultation by Dr. E. Reinhard on Dec. 19, 1953, when he complained of progressive fatigability, weakness, and dyspnea. Six months prior to this date he noticed that he was pale. He then developed progressive dyspnea on exertion, anorexia, an 8-lb. (3.6-kg.) loss of weight, impotence, a bruising tendency, furuncles, and epistaxis. In his work he had had some contact with benzene, nitrobenzene, chlorbenzene, and zinc dust. Because he was anemic, he was given blood transfusions. His history was negative, except for an isolated attack of asthma in 1938 that he attributed to the inhalation of chemical dust.
On admission the patient's blood pressure was 130/80 mm. Hg, his temperature was 98.6 F (37 C), and his pulse rate was 80 per minute. There were a few small, fading ecchymoses on his extremities. The tip of his spleen was palpated
Ramos AJ. PRESENTATION OF CASE. JAMA. 1956;161(1):60–61. doi:10.1001/jama.1956.62970010012016
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