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The influence of ACD and CPDA-1 anticoagulants, and storage time for 3 and 6 months on F VIII:C activity were compared in cryoprecipitate obtained at -70 degrees C, and -30 degrees C plasma freezing temperature. To eliminate variations in F VIII:C activity between donor plasma, the cryoprecipitation at -70 degrees C and -30 degrees C was made in paired plasma volumes (approximately 100 ml) from each blood unit. Employing ACD plasmas (n = 50), there was no significant difference in F VIII:C activity between cryoprecipitate prepared at -70 degrees C (mean = 31.1 IU/bag) and -30 degrees C (X = 30.5 IU/bag), and the storage did not modify F VIII:C activity. In contrast, in cryoprecipitate prepared from CPDA-1 plasmas (n = 31), the F VIII:C levels obtained at -30 degrees C (mean = 43.8 IU/bg) were significantly higher than those at -70 degrees C (mean = 37.3 IU/bag), but a deterioration of F VIII:C activity (about 50%) was observed after 6 months of cryoprecipitate storage. Therefore, if cryoprecipitate is stored it would be more convenient to use ACD instead of CPDA-1 and make cryoprecipitation either at -70 degrees C or -30 degrees C.

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.

Summary Five very severe post-transfusion reactions occurring in a hospital within a one month period are reported. The reactions were characterized by profuse generalized bleeding, cyanosis and severe hypotension. Marked thrombolysis was the only abnormality observed in the single adequately studied case to account for the bleeding. Four of the 5 patients died, 3 of them within 3 hours and the fourth after 3 days. Bacteriologic investigations of the blood flasks stored at the time showed that 15 out of 32 were contaminated, six of them by Gram negative bacilli. Four of these microorganisms appeared to be very similar and one of them was identified as Aerobacter liquefaciens. Their pathogenicity was confirmed in rabbits and dogs. Contamination was due to faulty sterilization of the equipment used for blood re-collection. Resume Dans l'espace d'un mois, 5 reactions post-transfusionnelles tres graves ont ete observees dans un hopital. Les reactions etaient caracterisees par des hemorragies generalisees et diffuses, de la cyanose et une hypotension grave. Dans le seul cas qui a pu etre etudie en detail la thrombolyse etait la seule cause qui puisse expliquer les hemorragies. 4 des 5 patients sont morts, 3 d'entre eux dans les 3 heures et le quatrieme 3 jours apres les transfusions. Les examens bacteriologiques pratiques sur les conserves de sang preparees a cette periode ont montre que 15 flacons sur 32 etaient contamines, dont six par des bacilles gram negatif. Parmi ces micro-organismes, 4 semblaient etre de meme souche et l'une d'entre elles a pu etre identifiee comme etant constituee par Aerobacter liquefaciens. La pathogenicite de ces micro-organismes a ete confirmee par des examens pratiques sur des lapins et des chiens. La contamination etait due a une sterilisation defectueuse du materiel de prises de sang. Zusammenfassung Es wird uber 5 sehr schwere Transfusionszwischenfalle berichtet, die im selben Spital innert eines Monats beobachtet wurden. Die Empfanger zeigten generalisierte Blutungen, waren zyanotisch und wiesen eine schwere Hypotension auf. Im einzigen eingehender unter-suchten Fall beruhten die Blutungen auf einer ausgesprochenen Thrombolyse. 4 der 5 Patienten starben, 3 innert 3 Stunden, einer nach 3 Tagen. Die bakteriologische Untersuchung der Blutkonservenreste ergab in 15 von 32 Fallen einen positiven Befund. Von 6 Konserven wurden gramnegative Keime gezuchtet. 4 dieser Keime waren sehr ahnlich; einer wurde als Aerobacter liquefaciens identifiziert. Die bakteriellen Verunreinigungen beruhten auf einer fehlerhaften Sterilisation der Transfusionsgerate.

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.

Summary. Case records of patients with anaemia due to lack of iron, vitamin B12 or folate, or to abnormal haemolysis were reviewed with regard to magnitude of reticulocytosis and rate of haemoglobin rise after therapy. Greater absolute reticulocyte values were observed in hereditary and acquired haemolytic anaemias. Furthermore, and more significantly, the rate of haemoglobin rise in autoimmune haemolytic anaemia responding to corticosteroid administration was greater than in the deficiency anaemias during adequate therapy. Additional data are presented supporting the old concept that erythrocytic production is greater in haemolytic anaemias than in deficiency anaemias after specific therapy.

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.

This work analyzes the possible causes of anemia in 2 groups of pregnant women observed in 2 different hospitals in Mexico City; 1 group of 216 patients, and another group of 121 women who were already in labor. Women in the first group were short, of low schooling, high gestation and parity, and high incidence of previous fetal losses. Women in the second group were taller, slightly better educated, but still with high gestation and parity, and high incidence of fetal lossed. Hematological data collected included hemoglobin level, packed cell volume, RBC folates, serum assay of iron, total iron binding capacity, and albumin. 23% of patients in the first group, and 17% in the 2nd. group were found to be anemic; the percentage rose to 49% and 35% respectively if patients with low hemoglobin level were also considered to be anemic. The principal finding of the study was that iron deficiency was present in 53% of cases of anemia, and that it was probably to be ascribed to nutritional deficiencies.

65 patients of gestational age 35.4 weeks, and of average age 27.7 were investigated during postpartum after delivery of stillborn babies, to measure hemoglobin, serum assay of iron, total iron binding capacity (TIBC), folates level, and vitamin B 12 level. Comparison with a series of 270 women in their third trimester of pregnancy showed that the first group of patients had lower mean hemoglobin level, lower serum iron level, lower TIBC, and lower serum folate level. There was no difference in transferrin saturation, and serum vitamin B 12 was higher. The percentage of anemic women was 50% versus 20% in the larger group; however, there was no difference in the prevalence of iron deficiency. There also was a direct correlation with B12 and serum folate. Further studies are needed to validate these findings.

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.

Androstane therapy in 34 new cases of aplastic anaemia together with the follow-up in 33 cases previously reported is evaluated. Thenew cases were of the acquired variety and had a hypoplastic marrow.

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 . . .

All subjects were adults, nine normal volunteers and three patients with iron deficiency classified on the basis of their serum iron and unsaturated ironbinding capacity. Two of the latter patients were slightly anemic1t (Table i) ; none received supplementary iron throughout the observation period. The serum iron was determined using the method of Peters et al. and the unsaturated iron-binding capacity by that of Finch and Rath.6 Two iron preparations were tested. One was a ferrous sulfate solution containing 6.66 mg. of iron per ml. The other solution had the same concentration of ferrous sulfate but also included 1 1.66 mg. of sorbitol per mg. of iron. No other iron preparations were used during either the observation period preceding the study or the study itself. The F&9 utilization tests performed in each subject were identical; the only variable being the presence or absence of sorbitol in the iron solution. For each of two fourteen-day trial periods, 0.5 mg. of

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.

Hemoglobin (Hb), packed cell volume (PCV), red blood cells (RBCs), mean cell volume (MCV), and mean cell hemoglobin concentration (MCHC) were measured by a single operator in a single laboratory by means of an electronic particle counter in 942 healthy adults (491 females and 451 males) residing at five altitudes: 0, 1000, 1860, 2220, and 2670 meters above sea level. The subjects were carefully screened clinically, and subjects with low transferrin saturation (less than 15%) were excluded. In both sexes there was a differential behavior as a function of altitude, of Hb and PCV on the one hand, and number of RBCs on the other. The findings suggest the presence of two sequential mechanisms of adaptation to progressively lower atmosphere oxygen pressure: One operating from sea level to 1860 meters, which leads to a progressively increasing number of relatively microcytic RBC; and a second one -- from 1860 to 2670 meters -- in which there is an increased but constant number of progressively more normocytic RBC, so that a simplistic model of equal magnitude increases in the three parameters and is seen at 2670 meters, but not at the intermediate altitudes. The middle group's comparativity, essential to these interpretations, apparently was achieved with regard to time elapsed between sampling and testing and with regard to the people integrating the groups.