The Pattern of Erythrocyte Sequestration in Immunohaemolysis: Effects of Prednisone Treatment and Splenectomy

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Abstract
The erythrocyte sequestration in the spleen and liver was investigated in 25 cases of immunohaemolysis by surface counting after infusion of 51Cr‐labelled autologous erythrocytes. The erythrocyte sequestration pattern was found to depend upon the treatment with prednisone given at the time of the investigation and furthermore upon the total haemolytic intensity.Increased sequestration of erythrocytes in the liver is always present in cases of severe hyperhaemolysis. After prednisone treatment, hypersequestration of erythrocytes in the spleen predominates. In the present study increased sequestration in the liver was even demonstrated in about 50 % of the cases in which incomplete non‐complement‐fixing antibodies were found.In the majority of cases prednisone therapy gave only short‐lasting remission. Frequently, it is difficult to reduce the dose of prednisone because of increasing haemolytic intensity.Complete, long‐lasting remission seems to follow splenectomy in cases characterized by a splenic sequestration pattern during periods without prednisone therapy, but if hepatic hypersequestration has been demonstrated the remissions are not complete. The need for steroids decreased after splenectomy in practically all cases. A combination of prednisone therapy and early splenectomy is advisable in most cases of immunohaemolysis.