IDIOPATHIC ACQUIRED HEMOLYTIC ANEMIA TREATED BY ACTH AND CORTISONE*

ACQUIRED hemolytic anemia is a rare and chronic disease often accompanied by severe hemolytic crises. The red cell injury appears directly related to eryth-rocyte bound antibodies x which may be detected by the Coombs ' test.2 Numerous investigations have indicated that antibodies are produced by lymphocytes 3 and possibly by the reticuloendothelial system.4 Attempts to destroy lymphoid tis-sue, and therefore the source of these injurious antibodies, by x-ray, nitrogen mustard and urethane, or to inhibit the reticuloendothelial system by Congo red saturation, have been of limited value.5 Splenectomy, which removes the largest lymphoid and reticuloendothelial organ in the body, has been of benefit in some cases, but it has a high mortality during a hemolytic crisis. ACTH and corti-sone have been shown to cause regression of lymphoid tissue in lymphomas 6 and to alter favorably the pathologic sequelae of numerous allergic states.7 It is therefore not surprising that improvement has occurred in the few cases of idio-pathic and symptomatic acquired hemolytic anemia in which these hormones have * Received for publication June 20, 1951