Four cases of acute acquired haemolytic anaemia in childhood treated with A.C.T.H.

In the early years of the present century the French school of haematologists appreciated that acute acquired haemolytic anaemia was dependent upon the presence of abnormal antibodies in the blood (Chauffard, Troisier and Vincent, 1908; Hayem, 1908; Widal, Abrami and Brule, 1907). During the first world war this important work was largely forgotten. Although Lederer (1925, 1930) gave his first classical description of the clinical picture in 1925, it was not until 1940 that Dameshek and Schwartz (1940) again stressed the immunological aspects of the disease. More recently, improved technical methods (Dacie and de Gruchy, 1951) have made possible the demonstration of abnormal antibodies in many cases in which gross agglutination is absent, thus confirming the early studies. The reason for the development of these abnormal antibodies is still obscure, but an infective origin for acute acquired haemolytic anaemia has long beeni postulated. This theory has recently received some support from the work of Hagberg (1952). He was able to demonstrate considerable diminution in the survival time of normal red cells transfused into children suffering from apparently simple post-infective anaemia. The knowledge that A.C.T.H. and cortisone interfere with antibody reactions has given fresh significance to these findings. During the last two years numerous reports (Best, Limarzi and Poncher, 1951; Crary and Beck, 1952; Dameshek, 1950; Dameshek, Rosenthal and Schwartz, 1951; Dameshek and Rosenthal, 1951; Davidson, Duthie, Girdwood and Sinclair, 1951; Etess, Bassen, Litwins and Sussman, 1951; Gardner, 1950; Gardner, McElfresh, Harris and Diamond, 1951; Langeron, 1951; Ley and Gardner, 1951; Mallarme, Martin, Eyquem and Fleury, 1951; Meyer, 1951; Rosenthal, Spaet, Goldenberg and Dameshek, 1952; Unger, 1951; Young, Christian and Izzo, 1951) have dealt with the use of these drugs in the treatment of acute acquired haemolytic anaemia. Formerly, Dameshek and Schwartz (1940) drew attention to the value of splenectomy when blood transfusion alone was proving to be inadequate. Four cases of acute acquired haemolytic anaemia were admitted to hospital during a period of 16 days in March, 1952. The weather at the time was cold and damp. All four children lived in Leeds; two (H.S. and J.G.) in adjacent streets of a modern estate four miles from the centre of the city; one (V.E.) in a poor district three miles distant from the hospital; and the fourth (V.P.) on the outskirts of the city, some six miles from the other children. None of the children attended the same school, nor had any contact with the others before this illness. Because of the poor response to blood transfusions of three of these children (V.E., J.G. and H.S.) it was decided that A.C.T.H. should be tried.