The term nutritional anemia designates a type of anemia especially prevalent among infants of 1 and 2 years, currently thought to be due mainly to lack of iron, which, derived either from stores in the body or from food, is needed for building hemoglobin. The severe form of the disease is seen most frequently among infants who have too long been given an exclusive milk diet, but it is seen also among infants who have been offered a seemingly well balanced diet. In most instances the anemia tends to improve spontaneously, as a rule coincidentally with the increasing acceptance of a well balanced diet, but even in infants who recover spontaneously (i. e., without iron medication) the period of transitory anemia is a critical one, in which the hazards of intercurrent infection and general nutritional disturbances are increased. The evidence produced by recent investigations 1 that there is a higher morbidity among anemic infants than among nonanemic infants emphasizes as a major pediatric problem the need for increased prevention of the condi¬ tion as well as for better aids to its early diagnosis and cure.Several extensive investigations of the hemoglobin content of the blood of normal infants, the results of which have been published during the past few years, have emphasized the fact that nutritional anemia is more prevalent than is generally recognized. Mackayla examined 4,811 samples of blood from infants of the poorer classes of London and reported that at 12 months of age 42 per cent of the breast-fed infants and 70 per cent of the artificially fed infants were definitely anemic. At Madison, Wis., Elvehjem, Peterson and Mendenhall2 reported the results of a determination of the hemoglobin content of 2,000 samples of blood from 740 children ranging in age from birth to 5 years. Approximately 38 per cent of the children at 1 year of age had less than 11 Gm. of hemoglobin per hundred cubic centimeters o: blood, and approximately 10 per cent had less than 10 Gm. The range of values between 10 and 11 Gm. constitutes a borderline zone for clinically recognizable anemia in infants of that age group. Most pedia¬ tricians recognize anemia in infants whose hemoglobin content is less than 10 Gm., but among infants who have between 10 and 11 Gm. anemia often goes unrecognized or is considered clinically insignificant. The hemoglobin level of the blood considered alone is, however, a less exact criterion of anemia in such infants than the alteration of the size and the hemoglobin content of the red cells, to which attention is mainly directed in this paper.The size and the coloration (i. e., hemoglobin content) of the red blood cells have been used as the basis for a classification of the anemias by a number of investigators. In a recent paper by Haden 3 such a classification is concisely summarized under a terminology which is employed by a number of writers at the present time, describing the red cells by terms designating normal, low or high values for their size and coloration, as follows: (1) normocytic, normochromic...
This paper presents a summary of hematologic data collected during the years 1932 to 1942. Some have been published previously in reports dealing particularly with problems of iron-deficiency anemia.1-5 At the time the studies were done plans were made for more complete statistical analysis of the assembled data, but various circumstances delayed the completion of that part of the project. The data are now presented in tables and charts designed to emphasize the sequence of changes in characteristics of the erythrocytes of infants and children at different ages and to demonstrate certain patterns of variability in those characteristics observed within different age groups.The data were derived from studies on 1735 samples of blood from infants and children selected at random, at ages from birth to 16 years. Of these, 1568 samples were from children born at full term, of single birth, and 167 samples were from twins, triplets, and prematurely born infants.Data from the latter were tabulated separately. These infants were treated as a single group because hematologically they appeared to follow similar patterns. For brevity these infants are referred to as the "premature group." Only a single sample was drawn from some individual infants, but from others samples were drawn serially at varying intervals while the infants were followed closely during periods of time from two to five years or longer. The ob¬ servations include samples from infants and children in the hospital, outpatient clinics, and orphanages, children both well and sick and from families of varying economic levels, but no patients with primary blood dyscrasias, and none who had ever received transfusions or any form of antianemic therapy. All were white, with known birth weight and birth order. Many studies on Negro infants were done but are not in¬ cluded in the present report because they did not represent a good sampling of the Negro population.We believe the subjects included in the present report comprised a representative sample of the white infant and child popu¬ lation of Cincinnati. Although most of the data were gathered 20 years ago, current observations in the hospital and outpatient clinic indicate that the incidence of iron deficiency disclosed by the indices here de¬ scribed remains essentially unchanged. Laboratory and Statistical Methods All measurements were made in the research laboratory. Blood samples were drawn by vein puncture and delivered into heparinized vials from which the blood was taken for the various tests. Hematocrit measurements were made in quadruplicate by the capillary tube method of Guest and Siler.7 For cell counting, duplicate dilutions were made in certified hemocytometer pipettes which were agitated mechanically. Double counting chambers were filled from each pipette, thus making quadruplicate counts for each blood sample. Hemoglobin was de¬ termined at first as carboxyhemoglobin by the Palmer method,8 later as oxyhemoglobin, in a photoelectric colorimeter. Both methods were standardized by determinations o...
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