Anaemias of Marasmus and Kwashiorkor in Kenya

Abstract

The hematologlcal findings in 47 children with marasmus and kwashiorkor are presented and the etiology and response to treatment is discussed. The anemias were mostly hypochromic or normochromic and were rarely severe. No association was found between the degrees of anemia and the serum protein levels. Erythropoietic activity of the bone marrow was extremely variable both on entrance to hospital and during recovery. Hypoplasia or aplasia was found in a considerable number of cases and was of two distinct types. One, occurring early, of short duration, associated with giant pro-erythroblasts, neutrophilla and infections and responding without hematinlcs as the infection subsided. Two, occurring late in recovery, of longer duration, unassociated with giant pro-erythroblasts or infections with a lymphocytosls and responding to riboflavine or prednisone. These aplasias are not associated with folic acid deficiency. Of patients with anemias refractory to all other therapy, 8% eventually responded to pyridoxine. The significance of excessive urinary indolic compounds and their relation to blocks in tryptophan metabolism and response to prednisone, riboflavine and pyridoxine is discussed. Megaloblastic anemia responding to folic acid was present in 17% of the cases and associated with low serum folic acid and normal vitamin B12 levels. Marrow hemosiderin was increased in the majority of patients on admission, although the mean corpuscular hemoglobin concentration, serum iron and unsaturated iron binding capacity levels were low. During recovery, as the serum proteins and unsaturated iron binding capacities increased, the serum iron, saturation index and marrow hemosiderin fell. Iron therapy was then required to effect full hematological remission. On entrance the absolute eosinophil count was low and fluctuated during the course of the illness, with infections. The possibility of the small lymphocyte being a multipotent stem cell in relation to erythropoiesis is discussed. The effect of intercurrent infections on erythropoiesis was a notable feature of these anemias and the lack of response to hematinics in the presence of active infection is stressed.