Autohemagglutinins and hemolysins with hemoglobinuria and acute hemolytic anemia, in an illness resembling infectious mononucleosis.

CUTE acquired hemolytic anemia is uncommon, but dramatic in its clinical picture and often disastrous in its outcome. In 1940, Dameshek and Schwartz’ assembled about ioo cases reported in the literature since 1907, in which no definite etiology was evident. In addition, as cited by these authors, cases have been reported in which the anemia developed in association with definite or probable etiologic factors. These include malaria, infections with streptococci, staphylococci and certain anaerobic organisms, as well as tuberculosis, syphilis and anchylostomiasis; also pregnancy, lymphoma, leukemia, carcinomatosis; and, finally, various drugs, especially the sulfonamides but also arsenical preparations, phenyihydrazine and acetanilide. Hemolytic anemia has also been reported in association with atypical pneumonia of unknown etiology” ‘ and its occurrence in patients who have received sulfonamides is well established.4 Studies of these cases in regard to the presence of hemagglutinins and hemolysins have given varied resuits. The case of acute hemolytic anemia with hemoglobinuria which is herewith reported is of interest because of the association of the unusual combination of autohemagglutinins and hemolysins occurring in the presence of morphologic changes in the white blood cells and heterophile agglutinins in the blood serum consistent with infectious mononucleosis, together with a positive Donath-Landsteiner reaction and the absence of evidence of syphilis. The patient was observed during the acute stage of his illness by two of the authors (0. J. W. and L. B. E.) and more than two years later by the third author (R. P. 5.).