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ACQUIRED HEMOLYTIC ANEMIA TREATED WITH CORTICOTROPIN

William R. Best, M.D.; Louis R. Limarzi, M.D.; Henry G. Poncher, M.D.
[+] Author Affiliations

Aided by a grant from The Armour Laboratories.

Read before the Central Clinical Research Club, Nov. 2, 1950.


Chicago

From the Departments of Internal Medicine and Pediatrics, University of Illinois College of Medicine.


JAMA. 1951;147(9):827-830. doi:10.1001/jama.1951.03670260029009
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Idiopathic, acquired hemolytic anemia is an interesting and perplexing hematological syndrome. Until recent reports of remission following administration of pituitary corticotropin (ACTH), treatment has been unsatisfactory in a large percentage of cases. Use of corticotropin in this disorder was first reported by several investigators at the Blood Club meeting in Atlantic City during April, 1950. These informal presentations were later abstracted1 and other cases have been cited.2 A rapid change of the blood picture toward normal has been uniformly noted. Some cases have remained in remission for weeks to months, while others have required maintenance doses to prevent relapse. Whereas most studies of corticotropin effect on normals have failed to show significant alteration of circulating antibodies,3 some of these hemolytic anemia cases exhibited falling titers in the developing (Coombs)4 test and other hemagglutinins under therapy. In those cases so tested osmotic and mechanical fragilities returned to

REFERENCES

Gardner, F.:  In Discussion on ACTH in Leukemia, News and Views , Blood 5:791 ( (Aug.) ) 1950;.
Dameshek, W.:  In Discussion on ACTH in Leukemia, News and Views , Blood 5:791 ( (Aug.) ) 1950;.
Thorn, G. W.; Forsham, P. H.; Frawley, T. F.; Hill, S. R. Jr.; Roche, M.; Staehelin, D., and Wilson, D. L.:  Medical Progress: The Clinical Usefulness of ACTH and Cortisone , New England J. Med. 242:824 ( (May 25) ) 1950;.
Dameshek, W.; Rosenthal, M. C., and Schwartz, L. I.:  The Treatment of Acquired Hemolytic Anemia with Adrenocorticotrophic Hormone (ACTH) , New England J. Med. 244: 117 ( (Jan. 25) ) 1951;.
Gardner, F. H.; McElfresh, A. E.; Harris, J. W., and Diamond, L. K.:  The Effect of Adrenocorticotrophic Hormone (ACTH) in Idiopathic Acquired Hemolytic Anemia as Related to the Hemolytic Mechanisms , J. Lab. & Clin. Med. 37:444 ( (March) ) 1951;.
Young, L. E.; Christian, R. M., and Izzo, M. J.:  Some Newer Concepts of "Congenital" and "Acquired" Hemolytic Anemias , M. Clin. North America 35:571 ( (March) ) 1951;.
Unger, L. J.:  The Effect of ACTH in Acquired Hemolytic Anemia , Am. J. Clin. Path. 21:456 ( (May) ) 1951;.
Thorn, G.:  Hematologic Effects of ACTH and Cortisone, in Discussion on ACTH in Leukemia, News and Views , Blood 5: 785 ( (Aug.) ) 1950;.
Singer, K., and Motulsky, A. G.:  The Developing (Coombs) Test in Spherocytic Hemolytic Anemias: Its Significance for Pathophysiology of Spherocytosis and Splenic Hemolysis , J. Lab. & Clin. Med. 34:768 ( (June) ) 1949;.
Cole, W. H.; Walter, L., and Limarzi, L. R.:  Indications and Results of Splenectomy , Ann. Surg. 129:702 ( (May) ) 1949;.
Dr. Israel Davidsohn performed most of the serologic tests in these two cases.
Wright, C. S.; Dodd, M. C.; Bouroncle, B. A.; Doan, C. A., and Zollinger, R. M.:  Studies of Hemagglutinins in Hereditary Spherocytosis and in Acquired Hemolytic Anemia: Their Relationship to the Hypersplenic Mechanism , J. Lab. & Clin. Med. 37:165 ( (Feb.) ) 1951;.
Wagley, P. F.; Shen, S. C.; Gardner, F. H., and Castle, W. B.:  Studies on Destruction of Red Blood Cells: The Spleen as the Source of Substance Causing Agglutination of the Red Blood Cells of Certain Patients with Acquired Hemolytic Jaundice by Antihuman Serum Rabbit Serum (Coombs' Serum) , J. Lab. & Clin. Med. 33: 1197 ( (Oct.) ) 1948;.
Evans, R. S., and Duane, R. T.:  Acquired Hemolytic Anemia: Relation of Erythrocyte Antibody Production to Activity of the Disease: The Significance of Thrombocytopenia and Leukopenia , Blood 4:1196 ( (Nov.) ) 1949;.
Luisada, A.:  Favism: A Singular Disease Chiefly Affecting the Red Blood Cells . Medicine 20:229 ( (May) ) 1941;.
Jakobowicz, R.; Krieger, V. I., and Simmons, R. T.:  Value of the Coombs Test in Detection of Isosensitization of the Newborn , M. J. Australia 2: 143 ( (Aug. 7) ) 1948;.
Lange, K.; Gold, M. M. A.; Weiner, D., and Simon, V.:  Autoantibodies in Human Glomerulonephritis , J. Clin. Invest. 28: 50 ( (Jan.) ) 1949;.
Gardner, F. H.:  Transfer to Normal Red Cells of Agglutinin Demonstrable in Acidified Sera of Patients with Acquired Hemolytic Jaundice , J. Clin. Invest. 28:783 ( (July) ) 1949;.
Siebens, A. A.; Zinkham, W. H., and Wagley, P. F.:  Observations on the Mechanism of Hemolysis in Paroxysmal (Cold) Hemoglobinuria , Blood 3: 1367 ( (Dec.) ) 1948;.
Mayer, M. M.; Osler, A. G.; Bier, O. G., and Heidelberger, M.:  The Activating Effect of Magnesium and Other Cations on Hemolytic Function of the Complement , J. Exper. Med. 84: 535 ( (Dec.) ) 1946;.

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Gardner, F.:  In Discussion on ACTH in Leukemia, News and Views , Blood 5:791 ( (Aug.) ) 1950;.
Dameshek, W.:  In Discussion on ACTH in Leukemia, News and Views , Blood 5:791 ( (Aug.) ) 1950;.
Thorn, G. W.; Forsham, P. H.; Frawley, T. F.; Hill, S. R. Jr.; Roche, M.; Staehelin, D., and Wilson, D. L.:  Medical Progress: The Clinical Usefulness of ACTH and Cortisone , New England J. Med. 242:824 ( (May 25) ) 1950;.
Dameshek, W.; Rosenthal, M. C., and Schwartz, L. I.:  The Treatment of Acquired Hemolytic Anemia with Adrenocorticotrophic Hormone (ACTH) , New England J. Med. 244: 117 ( (Jan. 25) ) 1951;.
Gardner, F. H.; McElfresh, A. E.; Harris, J. W., and Diamond, L. K.:  The Effect of Adrenocorticotrophic Hormone (ACTH) in Idiopathic Acquired Hemolytic Anemia as Related to the Hemolytic Mechanisms , J. Lab. & Clin. Med. 37:444 ( (March) ) 1951;.
Young, L. E.; Christian, R. M., and Izzo, M. J.:  Some Newer Concepts of "Congenital" and "Acquired" Hemolytic Anemias , M. Clin. North America 35:571 ( (March) ) 1951;.
Unger, L. J.:  The Effect of ACTH in Acquired Hemolytic Anemia , Am. J. Clin. Path. 21:456 ( (May) ) 1951;.
Thorn, G.:  Hematologic Effects of ACTH and Cortisone, in Discussion on ACTH in Leukemia, News and Views , Blood 5: 785 ( (Aug.) ) 1950;.
Singer, K., and Motulsky, A. G.:  The Developing (Coombs) Test in Spherocytic Hemolytic Anemias: Its Significance for Pathophysiology of Spherocytosis and Splenic Hemolysis , J. Lab. & Clin. Med. 34:768 ( (June) ) 1949;.
Cole, W. H.; Walter, L., and Limarzi, L. R.:  Indications and Results of Splenectomy , Ann. Surg. 129:702 ( (May) ) 1949;.
Dr. Israel Davidsohn performed most of the serologic tests in these two cases.
Wright, C. S.; Dodd, M. C.; Bouroncle, B. A.; Doan, C. A., and Zollinger, R. M.:  Studies of Hemagglutinins in Hereditary Spherocytosis and in Acquired Hemolytic Anemia: Their Relationship to the Hypersplenic Mechanism , J. Lab. & Clin. Med. 37:165 ( (Feb.) ) 1951;.
Wagley, P. F.; Shen, S. C.; Gardner, F. H., and Castle, W. B.:  Studies on Destruction of Red Blood Cells: The Spleen as the Source of Substance Causing Agglutination of the Red Blood Cells of Certain Patients with Acquired Hemolytic Jaundice by Antihuman Serum Rabbit Serum (Coombs' Serum) , J. Lab. & Clin. Med. 33: 1197 ( (Oct.) ) 1948;.
Evans, R. S., and Duane, R. T.:  Acquired Hemolytic Anemia: Relation of Erythrocyte Antibody Production to Activity of the Disease: The Significance of Thrombocytopenia and Leukopenia , Blood 4:1196 ( (Nov.) ) 1949;.
Luisada, A.:  Favism: A Singular Disease Chiefly Affecting the Red Blood Cells . Medicine 20:229 ( (May) ) 1941;.
Jakobowicz, R.; Krieger, V. I., and Simmons, R. T.:  Value of the Coombs Test in Detection of Isosensitization of the Newborn , M. J. Australia 2: 143 ( (Aug. 7) ) 1948;.
Lange, K.; Gold, M. M. A.; Weiner, D., and Simon, V.:  Autoantibodies in Human Glomerulonephritis , J. Clin. Invest. 28: 50 ( (Jan.) ) 1949;.
Gardner, F. H.:  Transfer to Normal Red Cells of Agglutinin Demonstrable in Acidified Sera of Patients with Acquired Hemolytic Jaundice , J. Clin. Invest. 28:783 ( (July) ) 1949;.
Siebens, A. A.; Zinkham, W. H., and Wagley, P. F.:  Observations on the Mechanism of Hemolysis in Paroxysmal (Cold) Hemoglobinuria , Blood 3: 1367 ( (Dec.) ) 1948;.
Mayer, M. M.; Osler, A. G.; Bier, O. G., and Heidelberger, M.:  The Activating Effect of Magnesium and Other Cations on Hemolytic Function of the Complement , J. Exper. Med. 84: 535 ( (Dec.) ) 1946;.
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