In vivo surface counting during survival studies with 51Cr-labelled red cells provides a means for determining the sites of red cell destruction. The principle is that the destruction of red cells in an organ is manifested by an increase in radioactive counts over that organ relative to the count rate over other organs and in the blood. By this means, it is possible to identify the principal site of red cell sequestration and destruction, and to determine the relative activities of the spleen and liver in a haemolytic process. Four patterns of surface counting occur: (1) excess accumulation in the spleen alone; (2) excess accumulation in the liver alone; (3) no excess accumulation in either organ; and (4) excess accumulation in both organs. Some congenital haemolytic anaemias (hereditary spherocytosis and hereditary elliptocytosis) generally fall into group (1); autoimmune haemolytic anaemias into group (1) or (4); hereditary non-spherocytic haemolytic anaemia into group (3); and paroxysmal nocturnal haemoglobinuria and cases of intravascular haemolysis into group (3) or (4). In patients with haemolytic disease, the results taken in conjunction with the clinical details of the patients have some value in deciding whether splenec-tomy should be undertaken. A good response can be expected mainly in patients who show the first pattern. Although this test is no longer often used, from published reports and personal data, it appears to give a 90% positive prediction that there will be at least a partial response to splenectomy and a 70% prediction of a full response.
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