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The Role of the Spleen in the Hemolytic Anemia of Cancer Patients* JOHNE.ULTMANN

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The Role of the Spleen in the Hemolytic Anemia of Cancer Patients* JOHNE.ULTMANN The Role of the Spleen in the Hemolytic Anemia of Cancer Patients* JOHNE.ULTMANN (Department of Medicine, Columbia University Collegeof Physw.iana and Surgeons and the Medical Services, Fraw Delaf&C1dandPresbyterian Hoapi@als,New York, N.Y.) With the demonstration that the anemia of scintillation probe (NRD Model 53) with an aperture of ap many patients with disseminated cancer is largely proximately 25 mm. was used. The body surface projections due to an increased rate of erythrocyte destruc of the heart, spleen, and liver were determined by physical examination and the centers marked with skin pencil. The tion (4), it became of interest to study the im scintillation counter surface was placed over the center of each portance of the spleen in this process. Jandl et al. organ at such an angle as to be approximately parallel with (5) and others (3, 7) reported the feasibility of the organ surface. Each of these angles was measured and re determining red cell sequestration in various organ corded for every patient, permitting exact duplication of physical factors at subsequent scanning. The body surface sites with Cr@'-labeled eiythrocytes. By this counts thus obtained were expressed as the ratio of radioactiv technic, patients with essentially normal red cell ity over the spleen or liver to that over the heart (spleen/ life spans, patients with clearly defined hemolytic heart—Sp/H; liver/heart—L/H). anemias, and patients with disseminated cancer Clinical material.—Thirty-eight patients from the wards of and hemolysis were studied. the Francis Delafield Hospital and Presbyterian Hospital were selected for the study of sed cell survival and body surface counting. MATERIALS AND METHODS Coomba testing.—Coombs tests were performed on all RESULTS AND DISCUSSION patients with commercial Coombs serum (Department of Compaiiion of surface counts before and after Health, City of New York) and 2 drops of saline-washed cells in 9 per cent suspension and 2 drops of Coombs serum. The death—Hughes, Jones, and Szur (3) have sum @ mixture was incubated for hour at 39°C. and read after 2 manized the major sources from which surface minutes of centrifuging. counts may be derived. Twenty minutes after in Labeling erythrocytes with Cr@'.—Red-celllabeling with jection of Cr@'-labeled red blood cells, surface radioactive chromium was performed by adding SO ml. of heparinized whole blood to 150 @zc.of Na2Cr―04 of high counts over an organ are due to labeled red cells specific activity (25.0—40.8pc/mg, diluted with normal saline in transit through the organ, red cells in the over-@ to a concentration of 30 @cCr@'/ml).The mixture was gently lying tissues, or scatter from other sites. During agitated for about 10 minutes, and the red cells were then al the course of study, counts due to red cells in lowed to settle for about 1—14hours. The supernatant plasma transit through an organ being scanned fall with was then drawn off. The residual red cells with any trapped plasma were administered to the patient. Twenty-four hours the decrease of radioactivity of the whole blood. later, and at appropriate intervals thereafter (usually every Jandl et al. (5) have shown that, with the injec week), samples of venous blood were drawn for determination tion of Cn51-labeled hemoglobin, there is a marked of hematocrit and red cell Cr@'activity. The radioactivity of the elevation of radioactivity over the liver, while blood was determined by counting 2-ml. aliquots of packed red injected Cr@'Cl3 is largely removed via the unine cells in a well-type scintillation counter. Counts were corrected for background and physical decay. No correction for elution An increase of radioactivity over the spleen, of Cr@'from the red cells was made. The data so obtained were or any other site, other than the liver, occurring expressed as a percentage of the radioactivity at 24 hours. concomitant with a fall of blood radioactivity as Surface scintillation couniing.—Bodysurface counting was approximated by counting over the heart, must done 20 minutes after the injection of labeled erythrocytes. Subsequently, each patient was scanned at the time of sample then be assumed to be due to sequestration of red collection for the Cr'1 red cell survival study. An uncollimated blood cells in that organ. Jandi et at. (5) showed that labeled sensitized red cells disappeared a Presented in part at the annual meeting of the American Association for Cancer Reserch, Philadelphia, Pennsylvania, abruptly from the circulation and that radio April 11, 1958. activity appeared promptly over the spleen. Al This work was supported in part by a grant (C 2332) from though this does not prove that intact red cells are the National Cancer Institute of the National Institutes of sequestrated in the spleen, it is highly probable Health, United States Public Health Service. that this is the case. Received for publication May 5, 1938. Summary table.—Table 1 summarizes the vital 959 Downloaded from cancerres.aacrjournals.org on September 26, 2021. © 1958 American Association for Cancer Research. @@@@@@@@@@@@@@@@@@@@@ z o@-@ -u.@a0 0@0 s@ a@ s@ s@ i@a-@ 2 @‘ 2 @00@@4.@.@.. 0@ .@ 0@@ a 0 I. ‘-I.@ .a ,@ I C@) @? l@t.. ;@? c@.@ C@a U 0 .@G5v0t'-—G@—•ast@.@000©—O©OOas 0O,-@O©©*@ @E•' @ ‘00 8@G@57,-@OO—OOO©@siI:@@‘0@*0 @,.@©[email protected]@G@_© 0 @ @@@o©©omi.,@‘ o‘0 00000OO©O@OOO©so@@t@-ao'o'o 00 t@ 0@0 o__oOO@O©OOOO0@OO©O@F@c2@o@G@000t..“‘ao—@e@n 0 —@ @ rn CJM .0—. @ 9 , 5@ — @ 1.0)r@n)n@0@1•' @5@7O'@t-.@@_o “4“5 r)@1-@ @osu 5@ . “‘ 0 @ 0—E-@z ho-t@e@ @0_— t'.0 00—0—— 5@ 5,@5_o_oo_oo_@00,5e. .0 t'. 5, 505@@ 5,5,@5,@5,5@5,5, G@ 55 @-4 5—. 0000000— 0sOsO5@00 0000000005, 050000t@.@IO@OO 0 00 @ 0 @I5,5,,-'@G@00@5,0 .@ U) l•' -@ooo10 @@@ e.. o G@ 5, 5, o @‘ . 5, @.. 5@ 0 ‘-4U) — 0'S @ t'. ‘.som5@ 05, [email protected]@i@ @00 ‘05, c@ ri4 @L4 I I E i .p Q.. .4 ;@,U @ .I@ @li @, 1L@, I @ @1i:@E ,@a-i- z@.@ —ll.@ @i @@ 0@,2 @unn @ aç@@ 75 Qc)QQcc)c)c_?Q @n c_) cc) “a0 I) &)C1) @ _G55, ‘@ ‘0 @t..U)0 0'-s55G7@'S@5-5, 0 0 — 55 U) ‘0 t-. U) * -0-- — — — — — — — — — — 55 55 55 55 55 55 55 55 5555 Downloaded from cancerres.aacrjournals.org on September 26, 2021. © 1958 American Association for Cancer Research. @ .@ IJLTMANN—HemOlytw Anemia of Cancer Patients 961 @@ .@‘ statistics, diagnosis, hematologic data, and results @@@ .@ .@ .@ a p.. of the present study for each subject. Except @@@@@ $@ ‘@ s@ where specifically stated, each patient was given @@@ .@ .@ .@ t Cr@'-labeled autogenous enythrocytes. For pur @@@@@ c@ @3 poses of this study, the patients with malignant @ .@ .@ r@ tumors were arbitrarily divided into two groups. 5@ 5@ 0-@ C1@ c!@ Those patients who had a 50 per cent erythrocyte survival beyond 925days were considered to have @@@@ ‘00 0 0 0 no evidence of hemoly-tic anemia. All patients with @@@@ 0 0 ‘.@‘•@ 0@ 50 per cent erythrocyte survival of 925 days or less were considered to have frank hemolytic @ 0 55 t.. 55 t@ *0 anemia. No patients with evidence of external @ 5@ 5@ 5@ ,.@ 5@ 5, — — blood loss, uremia, or infection were included in M I the study. The body surface counts of each patient are also recorded in Table 1. In the column @ a ‘SCOt- t@ — . @@@@ “@ 0 T0 are listed the Sp/H and L/li ratios at the beginning of the study—i.e., 920minutes after in @@@@ 0 55 55 55 0 jection of Cr@'-labeled erythrocytes. In the column @@@ — ,- ,-@ “@ ,@ “Tmaj. Sp. are shown the Sp/H and LIlT ratios ;54 that were obtained at a time when the Sp/H ratio Cl) Q@ was maximal. In a number of patients, the maxi @ U) @ U) — .@— 0 ‘0 t@. mal increase in radioactivity over the spleen oc I-' a — 55 — — — — — curred after the time of red cell half-life. This is in @ z contrast to patients with intrinsic red cell defects, in which high splenic activity is apparent early. I- @@@ ‘u@ 0 X 55 0• 0@ Control subjects.—Patients with normal red @ 0 hI'@@ @@@ .E — 0 55 55 0 — cell survival and no neoplastic disease served as control subjects. There were three patients in this @ C@) @@@@@ IZ &@lgi @i @1 group (Table 1, patients 1—3).Chart 1 depicts a @ — representative result in one of the subjects. The cross-hatched area shown in the upper portions of @ z U) 5, 5, 0 0 0 0 the figures represents the range of the red cell life 0 span values in six normal volunteers, given a I- smaller amount of Cr@' (50 sc.) than used in the present study. In the subjects without neoplastic @@@@@@@@@ 0 disease and with nearly normal red cell survival, the ratios of spleen/heart and of liver/heart counts at zero time are less than one, and neither ratio in @@@@@ creases significantly above one with time. The ap @ U) ça4 ç54rz4 proximate range of Sp/[I and L/H ratios as ob tamed in these three patients is shown schemati cally in cross-hatched areas in the lower portions of all subsequent figures.
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