SECONDARY ANAEMIAS. 317 



lungs and serous membranes ; also, rarely, in the ovaries, tes- 

 ticles, heart, and brain. 



At the beginning of the disease the blood is found to be 

 normal, but soon the anaemia and cachexia become prominent. 

 When the anemia is pronounced, alterations in the size and 

 shape of the red blood-corpuscles occur, and a few nucleated 

 erythrocytes usually normoblasts may be noted, as in other 

 severe anaemias. 



The percentage-reduction in hemoglobin is often greater 

 than that of the red corpuscles a so-called chlorotic con- 

 dition of the blood. 



Cases are sometimes observed in which the spleen alone is 

 involved, and are described under the term splenic anemia. 



Secondary Anaemias. 



Whatever the cause of secondary or symptomatic anaemias, 

 they have certain common characteristics. There is usually 

 a greater percentage- reduction of hemoglobin than of red 

 blood-corpuscles ; in mild cases the number of red cells is not 

 reduced, though the haemoglobin varies from 60 to 75 per cent, 

 of normal. The individual corpuscular richness in hemo- 

 globin is never above par, as in pernicious anemia. In severe 

 cases the oligocythemia may be almost as great as in the latter 

 disease. Alterations in the size and form of the red cells 

 occur ; microcytes and megalocytes are sometimes noted, the 

 former more frequently, however. 



Poikilocytosis and degenerative changes vacuolation and 

 polychromatophilia occur in the red blood-corpuscles; nor- 

 moblasts, the presence of which may be regarded as evidence 

 of a regenerative effort on the part of the blood-making organs, 

 are likewise to be seen. 



The number of leukocytes varies considerably ; if there is 

 a leukocytosis, it consists of an increase in the polynuclear 

 neutrophiles. 



