Oral Hexamethonium Bromide in Essential Hypertension

Abstract

MIEDIC,AL JOURNAL followed up for periods varying from three months to two years, and, although it has not been possible to obtain follow-up blood pictures, in no cases have symptoms returned. DiscussionThe fact that these cases of anaemia are labelled idiopathic indicates that their aetiology is obscure. A combination of factors has probably rendered insufficient the amount of iron available for haemoglobin synthesis. It is less likely that there was an excessive iron loss by way of chronic' haemorrhage, although the possibility that this had occurred in the past cannot be ruled out. The deficiency of hydrochloric acid in the gastric secretions was probably one of the determining factors, but it cannot have been the primary cause, as four of the patients were not achlorhydric. Also, as noted by Davidson and Fullerton (1938), not all achlorhydric people are anaemic, and, whereas the incidence of achlorhydria increases with advancing years, idiopathic hypochromic anaemia in old people is rare.The possibility that the anaemia in Case 9 was a toxic manifestation of lead has already been considered. We have also pointed out that all but one of the men had less than three months' service. Probably the amount of extra physical exertion involved in their basic training was sufficient to produce symptoms in subjects previously anaemic but hitherto symptomless. This certainly was true of Case 20, in which the gross degree of koilonychia was evidence of a long-standing anaemia, and also of Case 5, in which an anaemic state had been demonstrated twelve months previously.There is, however, a further possible explanation. Cantarow (1947) states that 23% of the minimal iron intake is required for the manufacture of muscle haemoglobin and for use in muscle and other parenchymal cells. This iron is not available for blood haemoglobin formation, and blood haemoglobin may constitute an important source of iron necessary for growth. Davidson et al. (1933) have shown that persons with achlorhydria exist on an intake of iron which is very near the borderline. In most cases the first few months of the recruits' lives in the Army are accompanied by a marked increase in weight, due, in part, to enhanced development and hypertrophy of the musculature. This change is more pronounced in those previously immature and of poor physique. It may be that this abnormal demand for iron cannot be met by increased intake, on account of impaired absorption from the gut, and iron for the enhanced development is obtained at the expense of the blood haemoglobin. Thus either an anaemic state is produced or a latent anaemia is rendered obvious. SummaryAn account is given of 20 cases of idiopathic hypochromic anaemia occurring in young men.The majority of. cases showed a definite tendency to immaturity, and nail changes were present in some. The typical syndrome of hypochromic anaemnia as it occurs in women was not seen.Achlorhydria or hypochlorhydria was present in 16 of the cases. Of the remainder, normal gastric acidity was present in one and hyperchl...

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