SECONDARY ANAEMIAS 2OI 



should prevent an examiner's reporting against a pernicious anaemia 

 previously diagnosed. 



Poikilocytosis, polychromatophilia, and stippling are also features 

 of the disease. Normoblasts are far less frequent than megaloblasts 

 and there is usually a moderate lymphocytosis. Myelocytes may be 

 present, but their precursors, the myeloblasts, are probably more fre- 

 quently met with. 



Cases of pernicious anaemia show remissions during which the patient is ap- 

 parently on the road to recovery. Such improvements are only temporary. The 

 remissions may last from two months to possibly three or four years. Especially 

 in the anaemia of Dibothriocephalus latus do we have a picture of pernicious anae- 

 mia. It is supposed to be due to a toxin present in the heads of these tape-worms. 



Blood changes more or less like those of pernicious anaemia have at times been 

 noted in children with tuberculosis of bovine nature. The human strain of T.B. 

 does not seem to produce such changes. 



An acute disease showing a rapidly developing anaemia of the pernicious anaemia 

 type is verruga peruana in which the bone, marrow seems especially involved. 



SECONDARY ANAEMIAS. 



These are the anaemias which can be definitely traced to some dis- 

 ease not of the haemopoietic system. 



There are two main groups those following haemorrhage and those 

 secondary to various diseases. If the haemorrhage is sudden and great, 

 the resulting condition is one of oligochromaemia chlorotic in type. 

 Normoblasts are usually found after the third day. 



The low Hb. percentage is apt to continue for several weeks. There is also an 

 increase in the percentage of polymorphonuclears. 



It is a question whether prolonged operation or those requiring narcosis are 

 justified where the reduction in Hb. is under 40%. (According to Miculicz, 30% 

 is the minimum). 



Where the loss of blood is gradual, as in gastric cancer or severe haemorrhoids 

 the picture may more nearly approach that of pernicious anaemia. Secondary 

 anaemias usually show a moderate leukocytosis. In chronic nephritis and prolonged 

 suppurative conditions normoblasts and macrocytes are rare moderate poikilo- 

 cytosis with the presence of many microcytes being the rule. 



In fatal anaemia from chronic acetanilide poisoning high color index, macrocytes 

 and megaloblasts have been noted. 



In some secondary anaemias, as in syphilis, carcinoma, and tuber- 

 culosis, we have a chlorotic color index (chloro-anaemias). 



In secondary anaemias polychromatophilia, poikilocytosis, and punc- 

 tate basophilia (stippling )may be present. This latter is very marked 



