SECONDARY ANAEMIAS 237 



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

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



In pernicious anaemia there is usually an absence of free HC1, which 

 causes it often to be confused with gastric cancer. Cases of chronic 

 nephritis are also often much like pernicious anaemia but most difficult 

 of differentiation are affections of the spinal cord, such as tabes, etc., 

 the neurological manifestations of pernicious anaemia causing the 

 confusion. 



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 Oroya fever in which the bone marrow seems especially involved. 



SECONDARY ANEMIAS 



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 

 anemias 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 ansmia 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 

 in lead poisoning, but in certain cases of malarial cachexia it may be 

 equally prominent. The only form of nucleated red cell seen is the 

 normoblast, in very small numbers, or it may not be present. 



