HEMOLYTIC JAUNDICE AND MACROCYTIC HEMO- LYTIC ANEMIA: CERTAIN OBSERVATIONS

DURING the past six years opportunity has been afforded to study 35 patients f exhibiting evidence of hemolytic anemia or jaundice. These cases were divided as follows: 1. Microcytic (familial or congenital) type 20 2. Macrocytic (secondary or acquired) type 15 a. With liver disease 8 b. With Hodgkin's disease 3 c. With leukemia 2 d. With chronic bleeding into ovarian cyst 1 e. With hyperthyroidism 1 It will be noted that the cases in the second group were in all instances associated with other disease. The existence of a primary form of acquired hemolytic jaundice has been questioned more and more in recent years. There is little doubt that the vast majority, if not all of the cases of primary hemolytic jaundice are of the familial or congenital type. In the earlier literature (Eppinger x) , patients whose jaundice appeared first in adult life, and in whose family no other members were icteric, were often wrongly classified as instances of the acquired type. This was true even though fragile microcytes were demonstrated. One of the cases of familial hemo-lytic jaundice in the present series illustrates how easily such a mistake might be made. This patient, a male 22 years of age, had first become jaundiced at 19. Since then there had been varying degrees of jaundice and anemia. The spleen was markedly enlarged. Deeply staining microcytes were nu-merous in the stained smear of his blood. In hypotonic saline hemolysis of the erythrocytes began at 0.68 per cent and was complete at 0.42 per cent. (Control: Hi 0.44 per cent, H2 0.34 per cent.) Careful questioning of th