Book Review

The Haemolytic Anaemias, Volume 5: Drug- and chemical-induced haemolytic anaemias; paroxysmal nocturnal haemoglobinuria; haemolytic disease of the newborn

N Engl J Med 1999; 340:2010June 24, 1999

Article

The Haemolytic Anaemias, Volume 5: Drug- and chemical-induced haemolytic anaemias; paroxysmal nocturnal haemoglobinuria; haemolytic disease of the newborn
Third edition. By Sir John Dacie. 448 pp., illustrated. New York, Churchill Livingstone, 1999. $175. ISBN: 0-4430-6269-2

In an era of textbooks and monographs written by dozens of contributors, a book of substantial size by a single author is a bit of a rarity. When the book completes a five-volume work (volume 1 appeared in 1985) comprising 58 chapters and spanning more than 2000 pages, one is tempted to suggest that it ought to be renamed The Encyclopedia of Hemolytic Anemias. And considering that this is the third edition of a work that was first published in 1954 — before many readers of this review were born — one wonders under how many headings this book would have to be listed in a medical writers' Guinness Book of World Records. The single-handed author of all this is Sir John Dacie, a founding father and for decades the unchallenged guru of British hematology.

Previous volumes deal with hemoglobinopathies, diseases of the membrane and of the enzymes of red cells, and autoimmune hemolytic anemias. This final volume covers drug-induced hemolytic anemias, paroxysmal nocturnal hemoglobinuria (PNH), and hemolytic disease of the newborn. True to his word in the brief preface, Dacie places each item in its historical context, a task facilitated by the fact that, in the field of hemolytic anemias, he has personally known most of those who have made important discoveries. He then reviews recent developments, point by point, often by summarizing individual publications one after the other. Thus, coverage of work carried out in the 1960s and 1970s is no less extensive than coverage of more recent work and is certainly more extensive than that in virtually any contemporary review. The reading becomes lively whenever a concept is illustrated with a clinical case from the author's own experience at the Hammersmith Hospital (from which he retired in 1977). Together with those of the previous volumes, the photomicrographs are by themselves a wonderful collection. They are printed in black and white, because Dacie holds that this provides the sharpest focus on the morphologic abnormalities of red cells.

It is impossible in a brief review to do justice to the encyclopedic value of this work, which is truly a magnum opus. In what other textbook will the reader find one and a half pages on hemolytic anemias caused by spider bites, a paragraph on hemoglobinuria after ingestion of the mushroom Paxillus involutus, and an annotated list of all the non-Rhesus antibodies that can cause hemolytic disease of the newborn? Although such an extensive review of clinical observations befits a highly accomplished naturalist (it is well known that Dacie has an invaluable, professionally arranged collection of butterflies), Dacie's other strength is the ability to ask questions about pathogenesis and pathophysiology. This is most evident in the nearly 200 pages devoted to PNH, a veritable monograph within a monograph. Other reviews may provide colorful cartoons of all the glycosyl-phosphatidylinositol–linked proteins and of all the known mutations in PIG-A (the gene that encodes phosphatidylinositol glycan class A), but here we find spirited accounts of how in the late 1930s the author developed (at the same time as Thomas Hale Ham in the United States) the first useful diagnostic test for PNH, and of how in the early 1960s he formulated the notion that a population of red cells in PNH must arise through somatic mutation. Perhaps of even greater interest is that Dacie and his collaborators highlighted in the early 1970s the intimate, primary relation between PNH and aplastic anemia, clearly preempting the misconception that PNH is only a secondary complication of aplastic anemia after treatment.

In trying to pinpoint who is most likely to make use of this book, one has to admit that the book may prove awesome to busy practicing hematologists who seek a quick answer to an urgent clinical or therapeutic problem. By analogy: if one wants to find out how to get to Bordeaux, a good atlas will do, but to ensure a chance to taste the best vintages, what one really wants is an advanced enological guide to the vineyards in the area. For a comprehensive and scholarly account of hemolytic anemias, Dacie set the standard a generation ago with his four-volume second edition (published from 1960 to 1967). The third edition is a new gold standard, and it is doubtful that anyone else's work will ever surpass it. At a time when training in hematology–oncology has often come to mean training in only the oncologic aspects of hematology, a textbook that highlights the scientific basis and clinical relevance of hematology outside of cancer studies is doubly welcome. We can be immensely grateful to Dacie for writing it.

Lucio Luzzatto, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 10021