In a previous article1 I reported 7 cases of leukocytic exhaustion characterized by leukopenia with a normal differential count and an extreme neutrophilic shift to the left. In 3 cases (cases 1, 2 and 3), the white cell failure followed either overwhelming or prolonged infection, but in the other 4 (cases 4, 5, 6 and 7) there was no such strain on the marrow to account for the blood picture. It was assumed, therefore, that in the latter group some impairment in leukopoietic power had been present all along, and these patients were considered to have a low leukocyte reserve. In 2 of the cases in which there was supposed low leukocyte reserve (cases 6 and 7), marked abdominal distention was present at the time of the lowest counts, and it was thought even at that time that some relation existed between the abdominal findings and the blood picture,
VAN DUYN J. ROLE OF ABDOMINAL DISTENTION IN LEUKOCYTE EXHAUSTION. Arch Surg. 1942;44(2):339–352. doi:10.1001/archsurg.1942.01210200155011
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