CLINICAL APPLICATIONS igg 



CLINICAL APPLICATIONS 



1. It is impossible to estimate even the presence of anaemia, to 

 say nothing of its degree, without an examination of the amount of 

 haemoglobin. I have been repeatedly asked by highly skilled 

 clinical observers to examine cases presenting all the appearances 

 of anaemia in whom the blood has been in every respect normal. 

 The examination, therefore, should be made in all cases of supposed 

 anaemia, and the diagnosis should not be considered as established 

 until this has been done. 



The recognition of the degree of anaemia is advisable, in that 

 it permits the effect of treatment to be watched and ineffective 

 remedies to be discontinued. It also affords a guide as to prog- 

 nosis, for if a patient's amount of haemoglobin increases during, 

 say, the first week of treatment, a good prognosis may be given, 

 although there are no other signs of improvement, and some 

 idea as to the time necessary to effect a complete cure may be 

 obtained. 



2. Apart from an ordinary anjemia, the estimation of the haemo- 

 globin may give an important clue as to the presence or absence 

 of other .diseases. For instance, in severe sepsis there is usually 

 a very marked and rapid fall in the amount of haemoglobin, due to 

 the destruction of the red corpuscles by the toxin of the infective 

 organisms. This is especially valuable in that it occurs in severe 

 infections in which the leucocytes often do not undergo character- 

 istic alterations (p. 242). Thus, if an increasing anaemia is found 

 in a patient during the puerperium, it points strongly to puerperal 

 fever, and the prognosis is bad, assuming, of course, that there is 

 no haemorrhage or other cause of anaemia. 



In interpreting the results of this examination you must re- 

 member that when there is severe diarrhoea, sweating, polyuria, 

 or any other sym.ptoms in which there is a great loss of water, the 

 blood may be temporarily concentrated, and the amount of haemo- 

 globin (and of red corpuscles, but not of leucocytes, or not to a 

 proportionate extent) may appear to rise. Discount this in giving 

 a good prognosis in septic conditions from the increase in the 

 haemoglobin. A similar concentration may occur from mitral 

 disease or venous stasis from any cause. 



3. A fall in the amount of haemoglobin in a case watched from 

 day to day indicates haemorrhage, and is occasionally valuable in 



