STUDIES ON DESTRUCTION OF RED BLOOD CELLS: I. CHRONIC HEMOLYTIC ANEMIA WITH PAROXYSMAL NOCTURNAL HEMOGLOBINURIA: AN INVESTIGATION OF THE MECHANISM OF HEMOLYSIS, WITH OBSERVATIONS ON FIVE CASES

The disease syndrome of chronic hemolytic anemia associated with paroxysmal nocturnal hemoglobinuria was described as a separate entity in 1928 and 1931 by Marchiafava 1 and in 1931 by Micheli. 2 The clinical manifestations have been reviewed recently with the report of cases by Witts 3 and by Hamburger and Bernstein. 4 The pathologic observations in 2 cases, with a review of the literature, were reported in 1938 by Scott, Robb-Smith and Scowen. 5 Van den Bergh 6 in 1911 made important observations on the in vitro manifestations of this disease without distinguishing it from acholuric hemolytic jaundice. A preliminary report on the mechanism of hemolysis was published in 1937 by Ham; 7 these observations were confirmed in 1938 by Dacie, Israels and Wilkinson. 8 Jordan 9 in 1938 published independent observations on the hemolytic mechanism. The present communication deals with the relation of the acid-base equilibrium of blood to hemolysis in vivo and in vitro and with observations

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