Idiopathic Aplastic Anemia

Abstract

female, aged 4, was admitted to Lebanon Hospital Nov. 4, 1921. Family History.\p=m-\Parentsapparently healthy; no history of tuberculosis or syphilis; no members of the family have had any diseases of the blood or the blood forming organs. Patient has one sister who is healthy. Personal History.\p=m-\Fullterm, normal delivery; breast fed; normal physical and mental development during infancy. Measles at 2 years of age, no complications. Present Illness.\p=m-\Duringthe past two weeks she has had fever, has become more and more pale and weak; complained of pain in the abdomen. Physical Examination.\p=m-\Child apathetic; marked grayish white pallor; puffiness of the face, especially the eyelids; all the mucous membranes are very pale. Sciera bluish, not yellowish. No distinct enlargement of the lymph nodes. Heart: No murmur, no marked enlargement; regular but rapid (130). Lungs: Negative. Abdomen: Negative; liver and spleen not enlarged. Extremities: On the back of the left calf is an ecchymotic spot 2 cm. in diameter. Examination of the Blood.-November 4 : hemoglobin (Dare) 25 per cent. ; red blood cells, 750,000; white blood cells, 2,500; polymorphonuclears, 25 per cent. ; lymphocytes, 72 per cent. ; no myelocytes. The red cells show slight changes in form, size and color. No nucleated red cells. The results of the examination of the blood at various times are given in Table 1. Clinical Course.-As the child appeared to be moribund, she received a transfusion of 380 c.c. blood (father). To our great surprise she rallied, and made a gradual but progressive improvement. November 7 : Distinct improvement, less pallor, apathy and irritability ; improvement in appetite. Pirquet and Wassermann tests negative. Examina¬ tion of fundus (Dr. Barnert) : no hemorrhages. Urine: acid; specific gravity, 1.014; trace of albumin; occasional hyaline cast and a few white blood cells; no urobilin. Feces : no blood, parasites, or ova. Roentgenologic Examination (Dr. Scholz)-Chest: moderate swelling of the root glands ; slight increase in upper mediastinal shadow ; moderate enlargement of the heart to the left. Arm : increased porosity of the bones, moderate diffuse atrophy. November 11 : Rise in temperature to 106 F., no apparent cause. November 12 : Spleen just palpable. November 16: Spleen distinctly palpable. November 14: Rise in temperature to 105.5 F.; no visible cause. November 16 : A large ecchymotic spot appeared on the left side of the neck 3 cm. in diameter. November 18 : Tonsils red and slightly enlarged.

Aplastic Anemia

“…The urine was consistently normal, except on one occasion, June 9, when the presence of small amounts of urobilinogen, not sufficiently large for quantitative determination, was detected. Cultures of the throat secretions on June 6 proteus. Roentgenologic examination of the long bones on June 9 showed an irregularity on the inner aspects of the lower ends of the femora.…”