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A collaborative study of nutritional anemia in third trimester pregnancy was performed in seven Latin American countries. Laboratory measurements included hemoglobin level, mean corpuscular hemoglobin concentration (MCHC), serum iron and iron-binding capacity, serum folate, vitamin B12 and albumin. Iron deficiency (transferrin saturation below 15%) was found in 48% of pregnant women, as compared with 21% of nonpregnant females and 3% of male controls of comparable age. The prevalence of folate deficiency (serum folate below 3 ng/ml.) was 10%, 10% and 9% in these three groups, respectively. Vitamin B12 deficiency (serum level below 80 pg/ml.) was found in 15% of pregnant women, but in less than 1% of both control groups. Anemia, as defined by current WHO criteria, was found in 38.5% of pregnant women, 17.3% of nonpregnant women and 3.9% of men. Analysis of the frequency distribution for hemoglobin levels, based on a Gaussian distribution in normal subjects, suggested that a large portion of subjects considered anemic by WHO criteria were normal and that the true incidence of anemia in pregnant and nonpregnant females was 22 and 12% respectively. Correlation analysis indicated that iron deficiency was of major importance as a cause of anemia, while folate lack was contributory only in pregnancy; no relationship could be demonstrated between vitamin B12 deficiency and anemia.

A case of chronic erythremic myelosis (Di Guglielmo) is presented; the diagnosis was established by clinical, hematologic, and pathologic data. The peculiar characteristics of this particular case are discussed, as well as the differential diagnosis from hemolytic anemia and acute leukemia.

The effect of RBC hemolysates on the recovery from anemia due to blood removal was studied in four dogs. For that purpose each dog was bled on two occasions to obtain similar degrees of anemia, and the erythrocytic production was measured during the 14- to 18-day lapse following each bleeding. A 2- to 3-month interval was allowed between bleedings. The erythrocytic production was evaluated by Cr51 determinations of the circulating erythrocyte volume (EV) after each bleeding and at the end of the 14- to 18-day lapse. During the control study, the dogs received iron intramuscularly and saline intraperitoneally; the latter was substituted by hemolyzed RBC during the test study. The erythrocytic production, in terms of ml. of EV gained per Kg. and per day, in every animal was higher during the test study: 1.126 to 2.411 (mean, 1.568) times the production of the same dog during the control study. The results furnish strong evidence that the products of erythrocytic destruction have an enhancing effect on the recovery of anemia induced by bleedings in dogs.

SummaryTwo dogs with anemia induced by bleeding were injected intramuscularly with iron dextran to replace the iron lost through the bleedings. They were given intraperitoneally 1.5 ml/kg/day of a hemolysate containing 15 g/100 ml of 59Fe-labeled hemoglobin. Seventeen and 24.7% of the injected heme-59Fe was reincorporated in the RBC, which accounted for only 13.9 and 11.9% of the iron present in the hemoglobin gained following injections of hemolysate. These results indicate that the 60.7% increase in hemoglobin production after hemolysate administration observed in previous similar experiments (1), cannot be ascribed to availability of large amounts of heme iron.

Results of electrocardiographic studies in 100 patients with severe anemia (less than 8 Gm. of hemoglobin) of various etiologies are reported. Thirty of them were studied serially during therapy. Hypoxic electrocardiographic changes were observed in 11 patients; these changes were seen to improve or disappear with the treatment in those patients who were studied at intervals throughout the course of therapy. The appearance of a peculiar electrocardiographic alteration during iron therapy in patients with iron-deficiency anemia is reported and its significance is discussed.

TO prove that a drug or chemical has an etiologic relation to aplastic anemia is a difficult task. This is due mainly to the low incidence with which their use is followed by the disease, making it necessary to accumulate a sizable number of suspicious cases to find a statistical argument in its favor. Thus, recognition of the aplastic-anemia-inducing effect of chloramphenicol, the most offending drug in this respect in the United States, was delayed for several years.1 Likewise, the indirect toxic effects of the insecticides are not widely recognized though a few cases of blood dyscrasias after their use . . .

Erythrocyte production was measured in 21 iron deficiency anemia patients after therapy with parenteral iron. The red cell mass was measured twice with 51Cr and red blood cell survival by labeling with 51Cr. In all cases, erythrocyte production increased in the 12 h following parenteral iron administration (dextran or polysaccharide-iron oxide). Production increased sharply for 3 to 6 days, remained high for 2 or 3 days and fell sharply thereafter. It is suggested that this fall is not due to a lack of available iron.