Protein-energy malnutrition and anemia in Kivu

Abstract

Protein-energy malnutrition in Kivu is associated with a discrete normocytic, normochromic anemia. An attempt to define the physiopathology of this anemia disclosed the following results. As compared with local controls, both iron and total iron binding capacity were low, but with siderophilin saturation and sideroblast counts either normal or elevated; serum and erythrocyte folate was normal, plasma vitamin B12 was normal or elevated, and serum ascorbic acid was normal or elevated. The riboflavin nutritional status was normal. During refeeding, iron and riboflavin deficiencies became apparent. Characteristic findings on admission were the presence of giant erythroblasts and a diminished erythrocyte survival time implicated to an intracorpuscular hemolysis. Two results from the present study could contribute to explanation for the aforementioned abnormalities: low plasma vitamin E levels and, perhaps more importantly, low plasma selenium levels. In conclusion, the anemia of protein-energy malnutrition, as observed in Kivu, is a classifiable nonadaptive anemia that cannot be explained by isolated iron or vitamin deficiencies and whose physiopathology is distinct from that of the anemia of chronic disorders. It is suggested that a selenium deficiency may play an important role in the pathogenesis of this anemia.

A Case Control Study of Hematological Changes in Children with Protein Energy Malnutrition Attending Gauhati Medical College and Hospital.

“…However, several other studies have shown leucopenia as well as neutropenia as a common finding in malnutrition. 18,19,20 The lower lymphocyte count observed in the present study and other studies can be attributed to the fact that thymus size gets reduced in children during severe PEM. 15 An important finding in the present study was a statistically significant difference in platelet count between cases and controls.…”

Haematological alterations in protein malnutrition

“…2,54 Fondu et al (1978), working with children from Zaire suffering from PCM, concluded that anaemia was due to a reduction in the mean life of erythrocytes, which in the population studied was 18 days. This suggests that an increase in erythrocyte fragility was due to a decrease in selenium and vitamin E. 55 Furthermore, these same authors suggested that amongst the causes for anaemia in PCM there is the adaptation of the organism to the reduction of the demand for oxygen and also to chronic infections, which are frequently present.…”

“…65 Even though leucocyte response is variable, there is evidence that situations in which malnutrition is not accompanied by other diseases, leucopenia is always present. 55,66 Hypoproteic diets or those with an inadequate composition of aminoacids have a neutropenic 67 and eosinopenic 68 effect. Endotoxins alter cell mobilisation not only dislocating "marginal" granulocyets, but also modifying the influx into the maturation compartment.…”

¿Puede usarse el receptor soluble de transferrina para diagnosticar anemia ferropénica y evaluar la respuesta al hierro en lactantes con desnutrición aguda moderada?

“…1,3,4 La ferropenia es la carencia nutricional más frecuente en todo el mundo; además, se observan anemia por inflamación y AF en los niños con desnutrición. [4][5][6] En la actualidad, las pruebas tradicionales para el diagnóstico de la AF no bastan. 7 Si se usan por separado, ninguna es lo suficientemente sensible o específica como para diagnosticar la AF.…”