Investigation of the Patient with ‘Cryptic Anemia’
THE term ‘cryptic anemia’ may not have originated with the late Dr. Russell L. Haden, but he popularized it, particularly among his students, for many years. The adjective cryptogenic seems to have no real advantage over the similar cryptic—defined as pertaining to that which is hidden, occult, secret, or mysterious. This is basically the meaning of the term cryptic anemia as applied to a pale patient whose complete and detailed history and physical examination fail to reveal specific and convincing evidence of the type or the cause of the anemia. The clinical investigation of such a patient is a challenge to the physician, first, because he already has prima facie evidence that the patient has a significant organic disease, and secondly in that it behooves him to establish as accurately as possible a specific diagnosis before consideration of therapy.
The physician, then, assumes the role of a detective who must utilize all of his resources, including diagnostic acumen, selected laboratory studies, and roentgenographic examinations. However, the physician is in charge of this investigation and it is a responsibility that cannot be transferred to the laboratory specialist or to others. An important facet of the investigation involves arriving at the diagnosis in the shortest possible time, with a minimum number of laboratory studies, and with the least cost to the patient. Therefore, the physician also must emulate the expert chess player and must try to establish a checkmate promptly.
Certain features of history-taking from the pale patient are particularly. . .