Critical review : polycythaemia, erythrocytosis and erythraemia.

  • Frederick Parkes Weber
Date:
1908
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Licence: In copyright

Credit: Critical review : polycythaemia, erythrocytosis and erythraemia. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    causation of the polycythaemia in the cases in question. It must, however, be admitted that blood-stasis, especially when due to chronic obstruction in the portal and splenic veins, may, at least in some individuals,6 give rise to poly- cythaemia with splenomegaly, that is to say, may give rise to the clinical symptom-complex ‘ splenomegalic polycythaemia which may be mistaken for true erythraemia. The cases of Reckzeh, Lommel, and van der Weyde and van Ijzeren (described in Appendix A) are probably, as Lommel insists, to be explained in this way, and such cases of clinically‘splenomegalic polycythaemia’ should not be included as examples of erythraemia according to our use of the latter term, as defined at the commencement of Part II. We have now considered the prevailing theory of erythraemia, which regards the polycythaemia in these cases as due to a c primary myelopathy and we have likewise considered the most important rival theory, which regards the poly- cythaemia as secondary to blood-stasis, but there are several other theories which have been brought forward, and, though by some writers they have been set up to be knocked down again, we must now shortly consider them. Other possible theories of erythraemia :—(a) Increased durability of the red blood-cells. There is no practical clinical method for measuring the average life-limit of the red corpuscles. H. Quincke in experiments on animals ascertained the time taken for the blood to return to its normal state after the artificial production of plethora. By his observations he estimated the normal average duration of life of the red cells at two to five weeks, but G. Froin by other methods of observation has estimated it at a much higher figure. Fick (quoted by G. Schroeder) suggested that the * polycythaemia of high altitudes ’ was due to an increased durability of the red cells resulting from residence in mountain resorts. But, as pointed out in Part I, it is almost certain that this polycythaemia of high altitudes is due to a genuine increase of the erythroblastic activity of the bone-marrow. Certainly in regard to the polycythaemia of erythraemia there is no evidence forthcoming that it is due to increased life-duration of the red cells, but on the contrary there is some evidence pointing to the total haemo- lysis in the body being increased, as one would expect it to be, in all cases of absolute polycythaemia. We have already dealt with this subject in Part I, under the heading ‘ Increased haemolysis in absolute polycythaemia ’, and need not add anything further to what we have already stated there. (b) Diminished oxygen-capacity of the haemoglobin, that is to say, diminu- tion in the amount of oxygen that the haemoglobin will take up as compared to the amount taken up by the haemoglobin in normal blood. Bence and von Koranyi suggested that absolute polycythaemia might in some cases be the result of a compensatory reaction towards some impairment in the quality of the haemoglobin which diminishes its oxygen-capacity. Mohr and Lommel have likewise paid attention to this question. Mohr actually found decided 6 As already explained, the erythropoietic reaction towards blood-stasis appears to vary much in different individuals. See Part I, Section on ‘Action and Vital Reaction in regard to Erythrocytosis ’. [Q. J. M., Oct., 1908.] I