Haemolytic Anaemia Complicating Virus Pneumonia

CASE REPORT The patient was a doctor aged 35. He had been fit except for sciatica due to a prolapsed intervertebral disc. His illness began two days before admission to hospital on July 8, 1948, when he developed aching in the limbs and severe headache. He had a rigor 24 hours after the onset and his temperature was then 105° F. There was a little serosanguineous nasal discharge at this time and a slight unproductive cough. He became disorientated and delirious. There were no contacts with a similar disease. Physical examination on admission showed photophobia, slight neck rigidity, and moderate cervical gland enlargement. Twenty-four hours later he was mentally clearer, and a slight rustiness of the sputum had appeared. The cerebrospinal fluid chemistry was nor ral. Haemoglobin, erythrocyte, and leucocyte counts were also normal. Sulphamezathine was started in full doses. On July 10, 1948, radiographs showed consolidation in the right middle lobe, though there were no physical signs. The cold agglutinin titre was 1:4. Bronchial breathing appeared over the middle lobe on July 13. He remained febrile whilst the blood picture and urine remained normal. The erythrocyte sedimentation rate (E.S.R.) was 54 mm.. in one hour (Westergren). Sputum culture produced no specific organisms. The E.S.R. fell to 34 mm. during the next few days and the cold agglutinin titre remained at 1 :4. The fever steadily subsided. On July 19 when almost afebrile he appeared to be very ill. He was obviously anaemic, slightly icteric, and had hepatic tenderness. Haemoglobin was now only 8.1 g. per 100 ml. (previously 14.1 g.). The urine showed a trace of bilirubin and no urobilin. Blood alkaline phosphatase was 8.5 units and thymol turbidity 0. Twenty-four hours later jaundice was deeper and the liver was enlarged. The cold agglutinin titre had now sharply risen to 1:1,000, and it was obvious that an acute haemolytic episode had occurred. On examination of the blood there was polychromasia, and 24 hours later 8O/^ reticulocytes with a total of 2,350,000 erythrocytes per c.mm. Improvement was steady after 48 hours, and on July 22 there were 2,500,000 erythrocytes with 11% reticulocytes and 12,000 leucocytes per c.mm., with a few myelocytes. The cold agglutinin titre was now 1:4,000; it remained at this level for a week and fell to 1:2,000 on Aug. 3. Thereafter improvement continued and the blood picture returned to normal. No further haemolyses have occurred (see Fig. 1).