Anaemias of Africans

Abstract

The anaemias of Africans in Kenya fall into the following types: (i) Microcytic hypochromic with non-dyshaemopoietic marrows; (ii) Microcytic hypochromic having dyshaemopoeitic marrows with giant stab-cells; (iii) Macro or normocytic with giant stab-cells; (iv) Macro- or normocytic with giant stab-cells and megaloblasts; (v) Sicke-cell anaemia; (vi) Haemolytic splenic anaemias. (i) responds to iron in any form, (ii) to a combination of iron and liver, (iii) and (iv) to all the known haemopietic substances as well as to penicillin, (v) responds to no form of treatment, (vi) to splenectomy. Sickle-cell trait grafted on to microcytic or megaloblastic anaemia is common and responds to the treatment for the appropriate anaemia. Methods are given for distinguishing between sickle-cell anaemia sui generis and sickle-cell trait grafted on to other types of anaemia. Giant stab-cells are regarded as definite evidence of dyshaemopoiesis and they respond slowly to haemopoeitic treatment. Megaloblasts, both typical, orthochromatic of the Ehrlich type, and the less typical intermediate forms, were common in our cases. Macrocytosis occurs without megaloblastosis, and megaloblastic marrows with normocytic blood pictures. Neither the marrow alone nor the peripheral blood alone is, therefore, a sound criterion for diagnosis or treatment. Mean corpuscular volume, even when reticulocytosis is taken into account, is not a satisfactory index of cell size, particularly diameter, and Price-Jones curves must be resorted to if a proper understanding of the relation between the variables M.C.V., M.C.D, M.C.A.T. and reticulocytosis is desired. Mean corpuscular volumes alone cannot, therefore, be used as a satisfactory means of diagnosing the anaemias. A series of Price-Jones curves is given, showing the variations in cell dimensions that occur at varius levels of reticulocytosis in both the hypochromic anaemias and the megaloblastic ones. A raised indirect van den Bergh is always present in the megaloblastic types of anaemia and is not related to malaria. As in pernicious anaemia, there appears to be an undercurrent of haemolysis in this type of anaemia, both in the African and the Macedonian cases. Peripheral bleeding due to intestinal parasites, or intravascular haemolysis due to blood parasites, cannot produce a megaloblstic marrow or giant stab-cells, and the presence of these abnormal cells in the marrow is indicative of disorders of haemopoiesis. Only a proportion of the anaemias of Africans in Kenya are due directly to parasitic infections. Raised temperatures are not uncommon in the heavy anaemias, especially the megaloblastic, as in pernicious. This is not necessarily evidence of infection, since the temperatures yield rapidly to treatment with such substances as liver, B₁₂ and folic acid. Attempt to treat the temperature and not the anaemia may be disastrous.