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Splenic volume was measured by visual assessment of planar images of the spleen, and also by single photon emission computerised tomography (SPECT) using 99mtechnetium tin colloid, in a group of 33 patients with primary thrombocythaemia (PT) or reactive thrombocytosis. Volumes greater than 337 cm3 correlated strongly though not absolutely with PT, all patients with volumes greater than this figure being in the PT group. Simple visual assessment of planar images by an experienced observer matched measured splenic volumes very closely.

CommentBenzylpenicillin has a molecular weight of 337 daltons,2 is to about 640', bound to plasma protein,4 and is effectively excreted by the kidneys-10", by glomerular filtration and 90o% by tubular excretion.5In an anuric patient the half life of penicillin is about 10 hours compared with half an hour in a normal person.5 Haemodialysis eliminates penicillin.2 Our patient, however, developed severe symptoms of intoxication despite regular dialysis three times a week. Evidently standard haemodialysis was insufficient to prevent an accumulation of penicillin from the large doses given. Our results indicate that carbon haemoperfusion is far more efficient than dialysis in removing penicillin and should be the treatment of choice for penicillin intoxication. Porphyria cutanea tarda and beta-thalassaemia minor with iron overload in mother and daughter Porphyria cutanea tarda has generally been classified as an acquired disorder of porphyrin metabolism. Recent reports, however, have suggested that it may also be familial, probably transmitted as an autosomal dominant trait.' A mother and daughter are decribed, both of whom had porphyria cutanea tarda and beta-thalassaemia minor. This led to iron overload, which responded to removal of iron. Case 1A Turkish housewife developed a photosensitive bullous skin eruption in 1964 at the age of 46. It settled within a month and did not recur. In 1968 she developed hepatosplenomegaly and was referred to this hospital. There was no history of excessive alcohol intake or of oestrogen treatment. A liver biopsy specimen showed portal fibrosis and grade II siderosis. Serum aspartate transaminase activity vas 17 IU/l (normal 5-17 IU/l), bilirubin concentration 9 ,umol/l (0 53 mg/100 ml) (normal 5-17 1imol/l; 0 3-1 0 mg/100 ml), and alkaline phosphatase activity 9 KA units/dl (normal 3-13 KA units/dl). Other investigations showed an excess of urinary uroporphyrins, 218 nmol (182 tzg)/24 h (normal 6-36 nmol (5-30,ug)/24 h), and low urinary coproporphyrins, 0 1 jtmol (65 ,ug)/24 h (normal 0 14-27 Mmol (90-175 jtg)/24 h). Porphyria cutanea tarda was diagnosed.In 1974 she was found to be anaemic with a haemoglobin concentration of 10-0 g/dl and a raised reticulocyte count of 5 00 (normal 0-2 00). Haemoglobin electrophoresis showed a raised HbA2 of 5 4%'O (normal 1-5-3-20%) and an HbF of 3-9 ("O (normal < 1-0 0o), compatible with beta-thalassaemia minor. Serum iron concentration was 17 9 ,umol/l (100 Htg/l00 ml) (normal 12 5-32 itmol/l; 70-180 ,ug/l00 ml) and total iron-binding capacity 59 ,umol/l (330 tig/100 ml) (normal 43-70 [Lmol/l; 240-390 ,ug/100 ml), but serum ferritin concentration was 1060 tLg/l (normal < 180 ,ugll). Repeat liver biopsy showed cirrhosis with grade III siderosis. Chemical liver iron concentration was 880 ,ig/100 mg dry weight (normal 20-130 ,ug/100 mg).HBsAg test was negative, but excess uroporphyrins were again detected in the urine.Chelation treatment with desferrioxamine 1 g/day by intramuscular injection was started. One year later the serum ferritin concentr...

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