THE HEART IN PERNICIOUS ANEMIA

Abstract

The death of a patient ill with pernicious anemia, a few hours after a transfusion of blood, with symptoms reported to be those of acute heart failure, brought home to me how little I knew of the heart in this disease. The patient referred to had only 660,000 red corpuscles per cubic millimeter of blood. A series of three blood transfusions was given, resulting in some improvement with the first, a moderate upset with the second, and a severe reaction after the third. This reaction was described by the physician in attendance as being characterized by dyspnea and the disappearance of the pulse at the wrist; the heart sounds remained audible. It began before the transfusion was complete, and persisted until the death of the patient about five hours later. What was the cause of the attack and subsequent death? Could there have been an embolus to the coronary artery,