Anaemia of Felty's Syndrome

Liver in Felty's Syndrome

“…Several factors may be implicated in the anaemia of Felty's syndrome, including those found in uncomplicated rheumatoid arthritis-namely, inadequate iron utilization for haemoglobin synthesis (Weinstein, 1959) and abnormalities of folate metabolism (Gough, McCarthy, Read, Mollin, and Waters, 1964)-as well as iatrogenic causes such as gastrointestinal bleeding from salicylate therapy. In addition, in Felty's syndrome, because of the splenomegaly, there may be increased haemolysis due to sequestration of red cells within the spleen (Hume, Dagg, Fraser, and Goldberg, 1964), as found in two of our patients. The present findings also show the importance of haemodilution, due to a large increase in plasma volume with a normal red cell mass.…”

Felty's syndrome. A clinical and pathological survey of 21 patients and their response to treatment.

“…However, pooling by itself cannot account for haemolysis in this sixth patient because it was also found in four patients with a normal red cell survival. While haemolytic anaemia in Felty's syndrome has been attributed to the direct action of the large spleen (Hume, Dagg, Fraser, and Goldberg, 1964) this does not seem to be the only mechanism.…”

Felty's syndrome. Good response to adrenocorticosteroids: possible mechanism of the anaemia.

“…de Gruchy (1964) frankly states that they are ineffective. Splenectomy is often of considerable value (Hutt et al, 1951;de Gruchy and Langley, 1961 ;Hume et al, 1964) but tends to be hazardous, especially in the elderly patient.…”

“…Further studies of red-cell volume indicated a reduction in the plasma volume from about 5.8 litres to about 4.3 litres (see Table). Hume et al (1964) thought the haematological improvement in their patients with Felty's syndrome after splenectomy to be due to the arrest of a haemolytic process, but they did not estimate plasma volumes. This has been done in other patients with anaemia and enlargement of the spleen whose plasma volumes were shown to be increased, notably by McFadzean et al (1958) in patients with cryptogenetic splenomegaly; by Bowdler (1963) in a patient with Gaucher's disease whose plasma volume was reduced by splenectomy; and by myself in cases of malignant blood diseases with splenomegaly (Pengelly, 1965).…”