THE DISCOVERY of iron and liver therapy has brought into prominence a type of primary anemia which fails to respond to any known treatment. This type has therefore been referred to as primary refractory anemia by Bomford and Rhoads,1 who have further subdivided it into four types according to the histopathologic appearance of the bone marrow. These, with their clinically comparable conditions, are pseudoplastic anemia (partly mature, cellular marrow), aplastic anemia, or panmyelophthisis (hypocellular marrow), chronic granulocytopenia (immature cellular marrow) and myelosclerosis (fibrosis, sclerosis, and giant cell hyperplasia of the marrow).
With the lack of specific therapy, the main source of treatment is repeated blood transfusions. A dramatic observation in cases of refractory anemia treated with multiple blood transfusions has been the development of hemosiderosis of the liver, spleen and other organs.
An analysis of autopsy observations in 20 cases of refractory anemia from Bomford and Rhoad's series revealed