IDIOPATHIC HYPOCHROMIC ANEMIA

Abstract

On the basis of 473 cases of a microcytic, hypochromic type of anemia usually associated with achlorhydria, which have been described in the literature, as well as 25 cases personally observed, the etiologic features, symptomatology, laboratory findings, pathology, diagnosis, treatment, course and prognosis, as well as pathogenesis of this anemia are discussed. It is defined as an anemia of unknown etiology occurring especially, but not exclusively, in women in the 3rd to 5th decades of life and one which is characterized by an insidious onset, long duration, symptoms such as are common to all anemias and, in addition, glossitis, stomatitis, dysphagia, paresthesias without objective neurologic findings, and often splenomegaly and koilonychia. In the great majority of cases there is evidence of disturbed gastric secretion (achlorhydria). The anemia is characterized by microcytosis and hypochromia, ready response to adequate Fe therapy and, very frequently, by a tendency to relapse when treatment is discontinued. The evidence so far available suggests that the fundamental disturbance may be defective gastric secretion with faulty utilization or synthesis from the diet of material which is necessary for hemoglobin formation. Anemia possibly develops because the demands for hemoglobin are in excess of the capacity of the individual to meet them. The requirements of menstruation and repeated pregnancies probably explain the preponderance of this type of anemia in women. Such factors as a diet deficient in foods potent for hemoglobin formation, excessive menstrual flow, blood loss from hemorrhoids, or dysphagia and consequent lack of food, are considered secondary aggravating factors and not primary etiologic agents. The advisability of recognizing this condition as a single entity is discussed.