Confronted with a case of severe anemia in an elderly woman, in which there had been a discharge of large quantities of bile through an external fistula more or less continuously for about three years, I naturally thought that it was a terminal condition due to malignancy, especially as the diagnosis of cancer had been made at the time of operative drainage. The question of pernicious anemia arose, however, on account of the complete achlorhydria and the progressive weakness of the patient over a period of several weeks. Liver extract no. 343 and preparations of fresh liver were therefore administered, with apparently no response; in fact, the cell count dropped from 1,360,000 red cells and 4,600 white cells on the patient's admission to the hospital to 1,050,000 red cells and 3,700 white cells twelve days later. Ferrous arsenite had also been given intramuscularly during this period. The total failure of
BALDERSTON SV. ANEMIA ASSOCIATED WITH BILIARY FISTULA. Arch Intern Med (Chic). 1932;50(2):223–225. doi:10.1001/archinte.1932.00150150055005
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