A new haemoglobin variant: haemoglobin Anantharaj alpha 11 (A9) lysine replaced by glutamic acid.

Four heterozygotes for a fast alpha-chain variant in a Thai family were detected on starch gel electrophoresis during a survey study on iron deficiency anaemia in a rural area not far from Bangkok. They were healthy and had normal haematological profiles except for the presence of around 44% abnormal pigment, quantitated by cellulose acetate electrophoresis. The structural characterization of the variant by globin chain separation, peptide mapping, and amino acid analyses of the abnormal peptides indicated that lysine residue 11 (A9) of alpha-chain was replaced by glutamic acid. This mutation has not been previously described and it is proposed that it be called Haemoglobin Anantharaj.

Emergency splenectomy in adult idiopathic thrombocytopenic purpura. A report of seven cases.

Seven adult patients with idiopathic thrombocytopenic purpura underwent emergency splenectomy. Six were female and one was a male, aged 16 to 61 years. All of them had a life-threatening episode. Six patients had progressive intracranial bleeding and one had postsurgical intra-abdominal bleeding. All patients were saved by surgery, except one for whom operation was delayed. There was no postoperative bleeding or surgical complication. Immediate splenectomy should be the treatment of choice in any patient with idiopathic thrombocytopenic purpura complicated by life-threatening hemorrhage.

A WHO collaborative study on iron supplementation in Burma and in Thailand.

Studies on the treatment and prevention of iron deficiency anemia, in pregnant and nonpregnant women and in men, were conducted in Thailand and Burma. The effects of the dose of Fe, duration of Fe administration, additional supplementation with folate, mode of supplement delivery (either supervised or unsupervised), and the presence of Hb(AE) were studied. The frequency and severity of side effects were also recorded. Fe administration resulted in an increase in hemoglobin concentration in all anemic individuals but approximately 20% failed to reach normality. The length of administration and the dose influenced the results. Frequency and severity of side effects increased with the dose of Fe administered. Folate supplementation did not affect the results. It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized.

PIP: 4 collaborative trials of iron supplements with or without folate on the following groups: adult men and women in central Thailand; pregnant women in northeastern Thailand; adult women in northern Thailand; and pregnant women in Burma, are reported as separate studies here. Subjects took 30, 60, 120 or 240 mg Fe sulfate with or without 2.5 mg folic acid. Those with chronic disease or hemoglobin 80 g/L were excluded. Presence of hemoglobin EE or EF, or hookworm infestations were determined in some cases. Hemoglobin E, which tends to increase incidence of anemia, occurs in up to 4.8% of women in northern Thailand, 27.6% of adults in northeastern Thailand, and 19% of pregnant women in Burma. Hookworm infection was a high as 35% in central Thais. Iron supplementation significantly increased mean Hb and reduced incidence of anemia in all study groups. 20% of subjects remained anemic. In northeastern Thailand treatment for 15 weeks resulted in higher Hb than did 10 weeks treatment. No significant difference was seen with dose of Fe or inclusion of folate. Supervised administration of supplements had no additional effect. Gastrointestinal side effects were a problem, and were dose related, but tended to resolve after a while. The fact that Hb levels did not rise to normal levels indicates that a combined program possibly including parasite control and food fortification should be considered.

G-6-PD variants in Chinese in Thailand.

Partial purified erythrocyte G-6-PD from 25 G-6-PD deficient southern Chinese male residents in Thailand was characterized. Five G-6-PD variants were found : G-6-PDs Canton (8), Dhon (or Taipei-Hakka) (8), Mahidol (or B (-) Chinese) (6), Haad Yai (1), and Hong Kong (1). One person whose enzyme was not fully characterized might have G-6-PD Haad Yai or a new variant.

Disseminated strongyloidiasis: report of seven cases.

Disseminated strongyloidiasis with associated infection from various organisms in 7 cases on corticosteroid therapy are reported. Either respiratory or abdominal symptoms or both without other obvious etiological factors are its usual clinical manifestations. The highly motile filariform larvae of Strongyloides stercoralis were demonstrated in sputum, gastric content, peritoneal fluid as well as in stool. Associated infection from various organisms were found in 6 cases and it is believed that these contributed to immediate cause of death since disseminated strongyloidiasis had been eradicated before death. Only one case survived. Thiabendazole therapy in conventional dosage is adequate in eradicating disseminated strongyloidiasis.