Anaemias of Africans in Kenya

Abstract

1. A survey has been made of the anaemias occurring in Africans in Kenya, and certain criteria laid down for their proper diagnosis. The macrocytic anaemias so far reported from Africa have turned out to be due to reticulocytosis, and not macrocytic in the usual meaning of that term. 2. The anaemias in Africans in Kenya fall into at least four fairly sharply defined groups. 3. In three of the groups Ehrlich's megaloblasts and/or giant stab-cells are present in the marrow, and hypersegmented neutrophils in the peripheral blood. The presence of these pathological cells clearly indicates that peripheral bleeding cannot be the only or even the most important factor involved in the genesis and maintenance of these anaemias. 4. There must obviously be some haemopoietic disturbance which results in a maturation failure resulting in the development of megaloblasts and giant stab-cells. Whether this haemopoietic disturbance is due to direct nutritional deficiency as in India and Macedonia is not yet certain. It is not impossible that worm infestation may interfere with the synthesis, absorption or utilization of haemopoietic factors as in the case of Dibothriocephalus latus infestation, in which cases peripheral bleeding due to the worms may be an additional complication. 5. The absence of reticulocytosis, and the presence of these pathological cells in untreated African cases, indicate both a depression of erythropoiesis and abnormal maturation that may be due to toxic factors connected with worm infestation and/or dietary deficiencies. 6. All those anaemias here which have pathological red and white cells in the marrow respond maximally to refined or crude liver extracts interparenterally, to marmite or folic acid by mouth, and more slowly to good hospital diet. 7. The rapid response of red cells to liver, marmite or folic acid outstrips the haemoglobin production, and unless iron therapy is given a hypochromic blood picture will develop. This failure of the haemoglobin to keep pace with red cell production may be due to depleted iron stores consequent on low iron content of the diet, to worms, or to both. It is recommended that iron therapy be given to correct lag in haemoglobin and haemopoietic substances to amend the maturation defect in the marrow. 8. The existence of a megaloblastic anaemia that is not macrocytic has been confirmed among Africans, and the problem of the fate of the megaloblast and the origin of macrocytosis is discussed. 9. The presence of anaemias with both Erhlich's megaloblasts and giant stab-cells, and others that have only giant stab-cells, suggests (1) that there may be red and white cell maturation factors in liver principle that are acting separately, or (2) that a profound deficiency produces upsets in both white and red cell maturation, a lesser deficiency affecting only the white cell line. Folic acid would appear to have only a “blood regenerating factor” since it leaves the nervous system of pernicious anaemia untouched. Liver treates both the blood and neurological symptoms of pernicious anaemia. 10. The association of a megaloblastic marrow with a normocytic normochromic blood picture may indicate that there is a third factor in liver principle controlling cell diameters. In liver disease macrocytosis occurs without megaloblasts. 11. All the cases have free acid in the gastric juice before or after histamine, but hypochlorhydria is common; two of the groups have raised indirect van den Bergh and positive Schumm's tests. 12. The response that three of the four groups of these anaemias give to marmite and the readiness with which the African takes to this substance, suggests that this might form a valuable dietary supplement in areas where diet is inadequate. 13. The Price-Jones curves are within normal limits in two of the groups—to the left in the microcytic hypochromic “worm” anaemias, and to the right in the megaloblastic macrocytic ones.