The results of the oral administration of high doses of anabolic hormones (oxymetholone, metholone or dromostanolone and methenolone) in the treatment of 69 patients (14 children and 55 adults) with aplastic anemia are presented. Remission rates were 48 per cent for the whole group and 70 per cent for those treated for more than two months. Twenty-two cases have been in remission for 1 to 5 years without maintenance therapy. Eight others relapsed 2 to 4 months after stopping therapy, but responded to the reinstitution of medication. However, four of them have had several relapses and appear to require permanent therapy. In the other four, the second remission has continued for 6 to 40 months. Clinical response was first noted after 0.6 to 6 months of therapy and was characterized by a rise of hemoglobin to normal levels with a variable degree of improvement in the leukopenia and thrombocytopenia. The number of neutrophils and platelets rose to normal levels in over a third of the cases which responded. Response to therapy was not related to age, sex, etiology, degree of pancytopenia or bone marrow cellularity. The three anabolic hormones seemed equally effective. Nine patients became clinically jaundiced during therapy; four recovered and five died. Abnormalities in liver function existed before treatment in three of those who died. In four of these five cases, the liver lesion was due to an independent cause: viral hepatitis in one, gram negative septicemia and necrotic colitis in two and thiazide toxicity in the fourth. No autopsy was performed in the other case and the etiology of his liver damage could not be determined. Three of the fatal cases were taking a non-17-alkylated steroid. Other patients presented mild, subclinical and nonprogressive rises in serum direct bilirubin and in BSP retention. The frequency of liver function changes was greater (80 per cent) with oxymetholone than with the other two non-17-alkylated steroids (26 per cent). The changes induced with the former drug regressed completely when metholone or methenolone was substituted. Other side effects were amenorrhea and mild virilization; no growth retardation or changes in bone maturation were observed. Our results suggest that some anabolic adrogenic steroids may be more useful than testosterone in the treatment of aplastic anemia.
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.
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.
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