Irregular distortion of the erythrocytes (acanthocytes, spur cells) in senile dementia.

An excess of irregularly distorted red cells with spiked forms (acanthocytes, spur cells) has been found in a substantial minority of patients with senile dementia of Alzheimer type (7 of 50 patients, 3 of 21 men and 4 of 29 women). Of 100 control patients, 42 men and 58 women), 5 (3 men and 2 women) showed comparable distortion, but, of these, one man may well have incipient dementia and the others had serious organic diseases which may be associated with comparable erythrocytic changes. The cause of the distortion is not yet clear, but the presence of occasional giant erythrocytes in the absence of general macrocytosis suggests a possible abnormality of cell-membrane synthesis. This distortion may be a useful marker in patients with loss of memory. Whether it is a manifestation of a haemopoietic clone or a constitutional anomaly associated with Alzheimer's disease remains to be seen.

Lead in neonates and mothers.

Blood lead was estimated in mothers post partum and infants at birth using the Jarrell-Ash 810 Atomic Absorption Spectrophotometer equipped with the Delves cup sampling system. 1665 pairs (mother and her infant) of blood samples were examined. The geometric mean for mothers and infants was 59.6 micrograms/l, SD = 25.2, and 40.7 micrograms/l, SD = 20.1, respectively. 3.5% of mothers had lower blood lead concentration than their infants. A significant correlation was observed between the blood lead concentration of infants and mothers, r = 0.8111, y = 0.6322x + 3.868 +/- 11.345. The haematocrit ratio was estimated in 1209 pairs. The geometric mean for mothers and infants was 0.3937, SD = 0.0402 and 0.5158, SD = 0.0499, respectively. No significant correlation was observed between the haematocrit ratio of infants and mothers. Similarly, no significant correlation was observed between the haematocrit ratio and blood lead concentration of mothers and infants. The examination of blood lead concentration for seasonal variation showed no significant increase in lead, although a significant drop in values was observed in spring and possible explanations offered.

Diagnosis and management of folate deficiency in low birthweight infants.

Significant folate deficiency in 14 out of 37 preterm infants of birthweights 2.0 kg or less was found to be reliably and most conveniently diagnosed by abnormal morphological changes in peripheral blood and confirmed by the response to folic acid. Deficiency appeared to be more common in light-for-dates infants including the smaller of twins. Neither the clinical status nor the levels of haemoglobin or erythrocyte folate was a reliable guide to the presence of megaloblastic erythropoiesis in the very young preterm infant. 100-200 microgram folic acid a day, orally or IM, may be required to ensure an optimal haematological response, and this would be appropriate for therapeutic trial if the diagnosis is in doubt. This amount would also replenish tissue folate stores; larger doses are likely to exceed the requirements of small infants.

Bone marrow iron and plasma ferritin in dialysed patients given intravenous iron-dextran.

Bone marrow biopsies have been taken in 28 patients on or approaching maintenance haemodialysis before and after treatment with monthly intravenous iron-dextran (Imferon). Stainable marrow iron was compared with blood Hb, plasma ferritin, erythrocyte protoporphyrin and MCH levels at the time of biopsy, and with previous or subsequent responses to iron in terms of blood Hb and MCH. There was a positive correlation between bone marrow iron and plasma ferritin levels both before and after iron therapy. All the patients with excess marrow iron had high plasma ferritin. However, six patients with low or normal marrow iron also had high plasma ferritin, two of these before iron therapy was given. Seven of the eight patients with no detectable marrow iron had low plasma ferritin. Three of the 28 patients failed to respond to iron with an increased blood Hb. MCH increased in all patients studied during iron therapy. All but one of the patients with high plasma ferritin prior to iron therapy responded well to iron. Although a good correlation between plasma ferritin and marrow iron can be shown in dialysed patients given intravenous iron-dextran, a high plasma ferritin level in an individual patient should not by itself preclude iron therapy.

In vitro autohaemolysis during pregnancy.

In vitro autohaemolysis with and without the addition of glucose was performed on normal pregnant women chosen at random and on non-pregnant women of comparable age. Autohaemolysis was significantly greater in the pregnant than the nonpregnant. The relationship between the stage of gestation and in vitro autohaemolysis in normal pregnancy may be fitted by a quadratic curve.

Bone marrow cellularity and iron stores in chronic renal failure.

Bone marrow biopsies of 15 patients with chronic renal failure (CRF) were compared with those of a control group matched for age and sex. Using a point-counting method for assessing cellularity, there was no significant difference in marrow cellularity between the CRF patients and the control group. There was a significant difference in the myeloid-erythroid ratio (p < 0.05) between the control group and the CRF patients, the latter group having a lower ratio. A point-counting method was used for the assessment of iron stores. Of 8 CRF patients who had not been given intravenous iron, oral iron or blood transfusion, 2 had greater iron stores than the control group.

Haemolytic anaemia of pregnancy.

Haemolytic anaemia apparently induced by pregnancy is reported in an otherwise healthy woman, with a negative family history. Folate deficiency, haemoglobinopathies, enzymopathies, hereditary spherocytosis, paroxysmal nocturnal haemoglobinuria, interstitial haematomata, hypertensive toxaemia, auto-immunity and infections were excluded. The autohaemolysis test showed increased lysis in the presence of added glucose. This abnormality was corrected by insulin when excess glucose was present, but not by insulin alone. It is suggested that this patient's erythrocytes may have been altered by placental lactogen and/or prolactin in such a way as to make them abnormally dependent on insulin for the uptake of glucose.