Histopathology in Prognosis & Therapy of Lymphocytic Lymphomas 219 

 needed two transfusions a week to maintain his hemoglobin between 6 and 



10 gm. 



Hyperhemolytic Syndrome 



Since the introduction of suitable techniques tor determination of red cell 

 survival, a group of severely anemic patients with hyperhemolysis, repre- 

 senting 10 per cent of all cases of chronic lymphatic leukemia, has been 

 recognized. 22, 44 - 57 Frequently the anemia is aggravated and the red cell sur- 

 vival shortened by cytocidal therapy.-- These patients may respond to 

 steroids; my own results have been unpredictable. In general, patients with 

 a positive Coombs test have responded better than those with a negative 

 Coombs test. 



Figure 17-8 is taken from Case 8, a patient with chronic lymphatic leu- 

 kemia with an extremely severe anemia and a very large spleen; both of the 

 latter were out of proportion to what would usually be expected in a patient 

 with chronic lymphatic leukemia whose white blood cell count was only 

 30,000. The anemia was demonstrated to be hemolytic in type. Transfused 

 genetically compatible red cells were completely destroyed in two hours. 



The patient's brother also had chronic lymphatic leukemia with a white 

 blood cell count of 30.000 and a hemoglobin of 16 gm. He was asymptomatic 

 and did not have lymphadenopathy or hepatosplenomegaly. His marrow re- 

 sembled that of Case 5 (Fig. M-bB, C, and D). 



The patient's marrow (Fig. 17-8/4 and B) had only a few islands of lym- 

 phatic tissue and was similar in this respect to her brother's as well as to that 

 seen in Case 5. Such a finding would ordinarily signify a relatively benign 

 disease. However, the remaining myeloid marrow had marked panhyper- 

 plasia of the three major marrow lineages and of plasma cells (Fig. 17-8,4 and 

 C). Upon further investigation a macroglobulin was demonstrated. The pa- 

 tient did not develop a remission folloAving x-ray therapy to the spleen, 

 although her spleen (Fig. 17-8/)), which had a fairly normal architecture, was 

 reduced in size and her white blood cell count fell to normal. After treat- 

 ment with prednisone, the concentration of the macroglobulin decreased, 

 the spleen became still smaller, the white blood cell count remained normal, 

 and the patient was able to resume her duties as a housewife. The survival 

 time of transfused compatible cells rose to fourteen days. 



Evaluation of the Role Played by the Marrow 



These cases illustrated the need to evaluate two interrelated factors in 

 chronic lymphatic leukemia, namely, the amounts of lymphatic and of 

 myeloid tissue. The mildest cases, i.e., those not needing treatment, were 

 characterized by a fairly normal amount of myeloid marrow. There were 



