Acute acquired haemolytic anaemia associated with herpes simplex infection.

Acquired haemolytic anaemia in childhood is a relatively uncommon condition. Lederer (1925) described three patients with acute haemolytic anaemia and in the literature up to 1938 Atkinson (1940) found 59 cases of 'Lederer's anaemia', 30 of which were in children. Millichap (1952) reviewed the papers published between 1940 and 1951 and found reports of a further 32 children with this disorder, the youngest patient affected being 6 weeks of age. Acquired haemolytic anaemia may develop after treatment with drugs such as quinine, sulphonamides, para-amino-salicylic acid, or after chemical poisons, for example naphthalene, benzene; it may be associated with general diseases such as leukaemia, lymphadenoma, liver diseases, lupus erythematosus; it may follow or be associated with infections either caused by bacteria (Streptococcus; Cl. welchii; Cl. tetanis) or by viruses (virus pneumonia, influenza A, coxsackie A, infectious mononucleosis, Newcastle disease, measles); but it is frequently unassociated with any obvious disease although investigations may point to the presence of autoagglutinins or auto-haemolysins. Boorman, Dodd and Loutit (1946) considered that congenital and acquired haemolytic anaemias could be distinguished by the antiglobulin (Coombs) test which was thought to be positive only in acquired haemolytic anaemias; but Wright, Dodd, Bouroncle, Doan and Zollinger (1951) have shown that the Coombs test may be negative in acquired haemolytic anaemia and positive in the congenital type. The stimulus to production of the antibodies in this disorder remains a mystery in many cases but the most likely explanation is that the antigen is derived from infective agents such as bacteria or viruses. The clinical features and results of investigations in a patient recently under our care are now described.