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There are three interdependent factors active in maintaining the normal red cell count: erythrocyte production, disintegration, and the life span of the red cell in the circulation. Shortening of the lifetime may be due to endogenous factors (i.e., faulty structure of the erythrocyte, abnormal hemolyzing activities), or may be caused by removal of erythrocytes from the circulation (hemorrhage).
With different methods, the true average lifetime was found to be from 100 to 120 days in dogs, monkeys, and man. Under strictly physiologic conditions, the disappearance of the red cells depends on their age. If pathologic mechanisms are at work, they concur with the physiologic processes and destroy the erythrocytes at random, irrespective of their age. The method of cross-determination of the lifetime of the erythrocytes (i.e., the survival time of normal cells in a patient with à hematologic disorder and of this patient's erythrocytes in a normal individual) demonstrates whether the cause of a disorder is due to an extra- or an intracorpuscular abnormality.
The lifetime of the red cells before and after splenectomy in dogs was found to be practically identical. After splenectomy the red cell population contained numerous target cells with increased resistance to hypotonic saline solutions; the longevity of these abnormally shaped cells is not prolonged.
Participation of the spleen in physiologic blood destruction seems to be absent or negligible. In certain hemolytic anemias (familial spherocytic jaundice, acquired hemolytic anemia) splenic hemolysis is present; it is selective, conditioned by abnormal properties of the erythrocytes which circulate through the organ. No evidence is available for the existence of a primary hemolytic “hypersplenism.” The diminution of the pigment excretion observed after splenectomy in human beings is not indicative of a decrease of blood destruction.
The hemolytic syndromes may be classified in two main groups: (1) disorders due to a variety of substances which, by acting on the red cells, injure their structure, and (2) diseases in which there are various and characteristic structural defects present in the red cells at the start of their life. The physicochemical changes responsible for the different structural alterations are unknown. Defective cells usually, but not always, have a shortened life span. Some defects make cells vulnerable to physiologic mechanisms.
Structural defects manifest themselves morphologically by changes in size, shape, and volume of the red cells, or functionally in such a way that pathologic cells, when injured by different substances, react differently (differential fragility). The many factors which cause pathologic hemolysis seem always to be qualitatively different from those responsible for the physiologic disintegration of the erythrocytes. However, if aging of the cell means physicochemical change in its structure, then physiologic and pathologic disintegration could be correlated in the future when a better knowledge of the characteristics of the various cell alterations may become available.
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Received: May 25, 1945The three interdependent factors active in maintaining the normal red cell level
© 1945 Published by Elsevier Inc.