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Hepatosplenomegaly, Abdominal Pain, Anemia, and Bone Lesions

Ernest Beutler, MD; M. Therese Southgate, MD
JAMA. 1973;224(4):502-510. doi:10.1001/jama.1973.03220170028007.
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[Protocol]  A 23-year-old white woman was admitted to City of Hope Medical Center four years ago for abdominal pain of three days' duration. The pain was severe and generalized and was aggravated by pressure and by deep breathing. She had vomited once.The patient's medical history began at the age of 3 years with an episode of pain in her left leg. A definitive diagnosis was not made, but a bruise and poliomyelitis were considered; treatment consisted of hot packs. Episodes of leg pain recurred, and when she was 5 years old her parents noted that she bruised very easily. She also developed pain in her right upper arm together with slight fever. A mass in the left upper quadrant (spleen) was first noted at this time. Hemoglobin value was 68% with a red blood cell (RBC) count of 3,800,000/cu mm; the platelet count was normal and the white blood


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