Discussion

Abstract

Erythrocyte sequestration was studied in 24 patients with chronic lymphocytic leukaemia (CLL) by infusion of autologous 51Cr‐labelled erythrocytes followed by surface measurements at regular intervals over the spleen, liver, and heart. To obtain a comparable expression of the accumulation of activity in spleens of different sizes, the splenic surface activities were corrected. The correction factors were determined using fluid‐filled balloons (simulating spleens) with the same amount of activity. In 19 patients with CLL the splenic erythrocyte pool increased with increasing spleen weight (500–4, 300 g). Moreover, the erythrocyte sequestration in the spleen increased with increasing pool. The maintenance of a large erythrocyte pool makes increased demands upon the erythropoiesis, which is perhaps already insufficient, and an increased splenic erythrocyte sequestration contributes to reducing the number of circulating erythrocytes. Splenectomy is invariably followed by increasing haemoglobin level and an average 30% increase of erythrocyte survival (22–48%). In cases of CLL plus splenomegaly the indications for splenectomy appear to be fairly simple, but may be supported by the demonstration of a large splenic erythrocyte pool and a large splenic erythrocyte destruction. The studies support the likelihood of lymphocytic infiltration in the liver (increased accumulation of activity), a finding which seems of prognostic significance.