Anaemia of Felty's Syndrome.

Since Felty's description in 1924 of a syndrome consisting of chronic arthritis, splenomegaly, and leucopenia, there has been much speculation on its essential nature. The condition has been considered to be an unusual variant of rheumatoid arthritis (Hutt, Richardson, and Staffurth, 1951) or simply the fortuitous association of chronic arthritis and cirrhosis of the liver with portal hypertension (Felty, 1924; Cudkowicz, 1956; Layani, Durupt and Amor, 1959). The leucopenia associated with splenomegaly has been explained on the concept of hypersplenism (Doan and Wright, 1946; Evans, Takahashi, Duane, Payne and Liu, 1951; Hutchison and Alexander, 1954; Dameshek, 1955). Less attention has been paid to the investigation of the anaemia which commonly occurs. It is of interest that each of the patients described by Felty had a haemoglobin of approximately 10 g. per cent. and that urobilin was detected in the urine of one patient; in many instances when splenectomy was performed there was a marked improvement in the anaemia as well as relief of the leucopenia (Smith and McCabe, 1948; Hutt and others, 1951; Hutchison and Alexander, 1954), but not in every case (Hutt and others, 1951; Cudkowicz, 1956). In this paper we have studied the mechanism of this anaemia both before and after splenectomy in four patients with Felty's syndrome.