832 GEOKGE K. MINOT AND AKLIE V. BOCK 



purpose to discuss the treatment of pernicious anemia. One must consider 

 the probability of remission as told by the history of the case, the character 

 of the blood, etc., as well as the desires of the patient and his family when 

 considering transfusion in this disease. 



In other, forms of chronic hemolytic anemia transfusion may be used 

 similarly as in pernicious anemia. However, it is possible that in a case 

 with increased blood destruction transfused corpuscles may perhaps re- 

 main in the circulation a shorter time than when a normal amount of 

 hemolysis is occurring. For this reason, among others, in some forms 

 of hemolytic anemia, such as chronic hemolytic jaundice, splenectomy is 

 the best treatment and transfusion then may be used to improve the con- 

 dition of the patient for operation. 



In anemia from blood, loss both acute and, particularly from chronic 

 types, in which no emergency exists for transfusion, remarkable results 

 may follow the use of this therapy. In addition to an increased output 

 of corpuscles from the marrow, a definite permanent alteration of the color 

 index of the corpuscles has been noted, in that the hemoglobin content per 

 corpuscle seems definitely increased. '' In such cases transfusion restores the 

 patient to health considerably sooner than with any other method of ther- 

 apy. In cases of chronic anemia due to blood loss, when the bleeding has 

 been stopped, the marrow may regenerate very sluggishly. Transfusion 

 enables such patients, who may be chronic invalids, to regenerate blood 

 and regain health often months earlier than without such treatment. 



Single and often repeated transfusion is also of value in aiding a 

 return to normal in other forms of chronic anemia, particularly if the 

 cause has been removed, or if it is anticipated that transfusion will 

 diminish the activity of the cause. A striking example of the effect of 

 many transfusions, when the cause of anemia has been removed, is seen 

 in severe benzol poisoning. This poison tends to produce aplasia of the 

 marrow and the resulting clinical and blood picture is that of aplastic 

 anemia with secondary purpura hemorrhagica. When the influence of the 

 poison is removed the blood may return to normal. However, in the severe 

 cases the trap seems to be sprung so far that the marrow is unable to re- 

 generate at the moment enough blood to maintain life. In some such 

 cases repeated transfusion performed about as often as bleeding recurs, 

 permits the patient to live during the time the marrow regenerates to a 

 point at which it can supply sufficient blood elements to maintain satis- 

 factorily the needs of the body. 



In idiopathic aplastic anemia transfusion appears to result in only 

 temporary benefit, for, unlike the cases of benzol poisoning, the unknown 

 cause is not removed. 



Besides the use of transfusion to stop hemorrhage and to prevent its 

 occurrence at operation in a patient having a hemorrhagic disease, repeated 

 transfusions may be used in certain conditions to accomplish the same 



