Chronic splenic anaemia and Banti's disease / by H.D. Rolleston.

  • Rolleston, Humphry Davy, 1862-1944.
Date:
1914
Catalogue details

Licence: In copyright

Credit: Chronic splenic anaemia and Banti's disease / by H.D. Rolleston. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    IO may be more than 5,000,000 per c.cm. In a case at St. George’s Hospital, the number of reds, which had been 3,200,000, went up to 6,000,000 before the fatal haematemesis. In cases in which the anaemia obviously depends on haemor- rhage, there is no need to invoke a toxic factor. The leucocytes are not increased in number, except as the result of a passing complication, and sometimes after a profuse haemorrhage. The usual condition is a leucopenia; the average of 14 of Osier’s cases was 4,520. Gulland and Goodall23 mention an extreme case with a count of 800. The cause of this leucopenia, which is also seen in tropical splenomegaly, is not known ; our present knowledge hardly justifies the hypothesis that auto-leucolysins or -leucocytotoxins (which dissolve leucocytes) are produced in the spleen, by the processes responsible for the fibrotic changes there. Banti believed that, though there was no inhibition of haematopoiesis, the elements of the blood were not discharged into the circulation. If this were the case, surely the lymphatic glands and bone marrow would be enlarged from retained blood- cells? In some cases, there is a relative increase in the lymphocytes, but no stress can be laid on this. A few myelocytes may appear in the blood in the late stages. Other Clinical Features.—There is no enlargement of the lymphatic glands, and the liver is not increased in size, until the condition is complicated by hepatic changes (Banti’s disease). Ascites has been reported in cases without cirrhosis of the liver,33 and is, perhaps, due to chronic perisplenitis. The urine is normal, though in the later stages it may be high-coloured. In some cases, there are attacks of colicky pain, probably due to traction and slight torsion of the peri- toneal ligaments of the spleen, or to dragging on perisplenitic adhesions. In other instances, there is merely a feeling of weight or discomfort on the left side of the abdomen. Many patients, however, are so free from localizing symptoms, that the splenomegaly is unsuspected until discovered on medical examination. Gastro-intestinal disturbance and indigestion are less frequent than might be expected as a result of the embarrassment due to the large spleen. Some patients suffer from diarrhoea; this, according to Banti, occurs in the transitional stage between splenic anaemia and Band's