Abstract
The essential characteristic of the condition known as paroxysmal hemoglobinuria is the occurrence, as a result of exposure to cold, of hemoglobinæmia and hemoglobinuria, usually accompanied by a chill and rise of temperature. In the blood of these patients there is present an auto-hemolysin which is readily demonstrated by the simple procedure well known as the Landsteiner reaction. In its simplest form it consists simply in chilling the patient's blood to 0° C. for 30 minutes, and then warming it to 37° C. In normal blood no hemolysis occurs after the blood has been warmed to 37°. More consistent results are obtained by using serum and a suspension of washed red cells, and by adding complement. This auto-hemolysin has been the subject of a number of studies which need not here be reviewed. The reaction has been shown to be an antigen-amboceptor-complement reaction with the characteristic that the hemolysin unites with the red cells only at a low temperature. It has also been shown that the combination of corpuscles and hemolysin occurring at low temperatures is at least partially broken up at higher temperatures, and that an iso-hemolysin demonstrated by chilling, as well as the auto-hemolysin, is present.
During the past three years we have had an opportunity to study the blood of three patients who are subject during the winter months to typical attacks of hemoglobinuria. Unless otherwise stated, the Landsteiner reaction has been done in our work by using 0.25 C.C. of serum, and 0.1 C.C. of a 5 per cent. suspension of washed red blood cells, and adding as complement 0.1 C.C. of pooled guinea pig serum diluted 1 : 10. The volume is made up to 0.5 C.C. with normal salt solution, and the tubes are then kept at 0° C. for 10 minutes, and in the water bath at 37° for 2 hours, when readings are made.
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