Normal Hemoglobin Values Research Articles

Same-day upper and lower endoscopy in patients with occult bleeding, melena, hematochezia, and/or microcytic anemia. A retrospective study of 224 patients.

The purpose of this study was to evaluate the role of same-day upper and lower endoscopy in patients investigated for non-acute gastrointestinal bleeding, manifested by occult bleeding, melena, or hematochezia and/or anemia suspected to be caused by gastrointestinal bleeding. A total of 224 patients, 127 women and 97 men, were reviewed. A potential bleeding source (PBS) in the upper gastrointestinal tract could have been missed in 25% of the patients if only colonoscopy had been performed. In nearly the same proportion of patients (26%) a potential bleeding source could have been missed if only esophagogastroduodenoscopy had been performed. Nine per cent of the patients had a potential bleeding source in both locations. Forty-six per cent (19 of 41) of the patients with a PBS in colon, other than colonic cancer, had a PBS also in the upper gastrointestinal tract. The chance of finding a potential bleeding source in patients with microcytic anemia and positive Hemoccult test is threefold higher than for the patients with microcytic anemia and negative Hemoccult test and twofold higher than in patients with normal blood hemoglobin value but positive Hemoccult test. Moreover, 22% (8 of 36) of the patients with microcytic anemia and a positive Hemoccult test had colonic carcinoma. Approximately 30% of the patients with a PBS had two or more PBSs in one or more organs. Eighteen per cent of 43 patients with a history of upper gastrointestinal symptoms had a PBS in the upper gastrointestinal tract. The corresponding figure for the patients without a history of upper gastrointestinal symptoms was 29%.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro storage and in vivo survival studies of red cells from persons with the In(Lu) gene

Red cells (RBCs) of individuals with the In(Lu) gene are characterized by suppression of the Lutheran, P1, i, and other blood group antigens, acanthocytosis, and abnormal electrolyte metabolism. To determine the clinical significance of these abnormalities, the survival of autologous RBCs was determined by 51Cr in two siblings with the dominant Lu(a-b-) [In(Lu)] phenotype. Both subjects studied had normal hemoglobin, hematocrit, reticulocyte count, haptoglobin, and ferritin values. RBC indices were mildly hypochromic. Examination of the peripheral smear showed mild acanthocytosis in one individual. Analysis of RBC distribution on discontinuous density gradients showed a shift to lighter fractions than normal control RBCs. Storage of these Lu (a-b-) RBCs at 4 degrees C showed significant hemolysis within a few days; this was confirmed by increased autohemolysis, which was reduced by glucose and ATP. RBC cation content (sodium and potassium) was higher than that in control cells, which indicated increased cell hydration, which explains the lighter density and mild hypochromia of the Lu(a-b-) RBCs. 51Cr survival of autologous Lu(a-b-) RBCs was normal in both subjects studied. The data indicate that the morphologic and cation abnormalities of RBCs of persons with the In(Lu) gene are clinically insignificant, as these cells have normal in vivo survival. Such RBCs, however, are susceptible to increased hemolysis in vitro under standard blood banking storage conditions. Individuals of the Lu(a-b-) phenotype, associated with In(Lu), may not be suitable candidates for routine blood donation.

The role of membrane skeletal-associated alpha-globin in the pathophysiology of beta-thalassemia

The beta-thalassemic mouse provides a useful model for testing hypotheses about the pathophysiology in human beta-thalassemia. The clinical picture of these mice and their red blood cell deformability characteristics are quite similar to those observed in human beta- thalassemia intermedia. The creation of transgenic mice that express human beta-globin (beta s) has provided an opportunity to study the effect of increasing the non-alpha-globin chain production on the thalassemic phenotype. A small increase in beta-globin production produces transgenic mice that are healthier, have almost normal hemoglobin values, and whose red blood cell deformability is increased. We quantified and characterized the membrane skeletal-associated globin in normal, transgenic thal/sickle, and thalassemic mice and showed that only alpha-globin was associated with the membrane skeleton in the pathologic red blood cells, and that the degree of rigidity as measured in the rheoscope correlated directly and closely with the amount of membrane skeletal-associated globin in these abnormal red blood cells.

The Role of Membrane Skeletal-Associated α-Globin in the Pathophysiology of β-Thalassemia

The beta-thalassemic mouse provides a useful model for testing hypotheses about the pathophysiology in human beta-thalassemia. The clinical picture of these mice and their red blood cell deformability characteristics are quite similar to those observed in human beta-thalassemia intermedia. The creation of transgenic mice that express human beta-globin (beta s) has provided an opportunity to study the effect of increasing the non-alpha-globin chain production on the thalassemic phenotype. A small increase in beta-globin production produces transgenic mice that are healthier, have almost normal hemoglobin values, and whose red blood cell deformability is increased. We quantified and characterized the membrane skeletal-associated globin in normal, transgenic thal/sickle, and thalassemic mice and showed that only alpha-globin was associated with the membrane skeleton in the pathologic red blood cells, and that the degree of rigidity as measured in the rheoscope correlated directly and closely with the amount of membrane skeletal-associated globin in these abnormal red blood cells.

Carotid and aortic bodies in chronically anemic normotensive and spontaneously hypertensive rats

Overactivity of the carotid body chemoreceptors along with the enlargement of chemoreceptor tissue were found in spontaneously hypertensive rats of Okamoto-Aoki strain (SHR). The purpose of the present study was to answer the question whether the aortic bodies were also enlarged in SHR. However, because aortic bodies, unlike carotid ones, are sensitive to oxygen content another question arose: do aortic bodies undergo hypertrophy in chronic anemia? Twenty-three spontaneously hypertensive rats of Okamoto-Aoki strain (SHR) and 24 normotensive Wistar rats (NCR) were maintained on low-iron food from the age of 3 weeks. In seven 10-week-old anemic SHR regular diet was substituted (transiently anemic SHR). Blood pressure measurements and hemoglobin were measured every second week. The animals were killed at the age of 18 weeks. Light microscopic studies of the carotid and aortic bodies were performed and volumes of chemoreceptor tissues were determined from serial sections. The eight SHR on low-iron diet exhibited lower hemoglobin concentration than their normotensive counterparts. In the anemic SHR blood pressure was lower than in control SHR, whereas blood pressure did not differ between the anemic and control NCR. Restoration of normal values of hemoglobin in the anemic SHR was followed by only a slight increase in blood pressure. The carotid bodies volumes were 2.5–3 times larger in the SHR than in NCR. The volumes of carotid bodies both of the SHR and NCR were influenced neither by blood pressure nor by hemoglobin concentration. The aortic bodies were more numerous in SHR than in NCR. Enlargement of aortic bodies found in the anemic SHR was not visible in the transiently anemic SHR. The aortic bodies of NCR were not affected by decreased hemoglobin concentration. Less severe anemia not followed by any changes in blood pressure in the NCR is a plausible explanation of the lack of enlargement of aortic bodies in these rats.

Macrocytosis and Leukopenia in Down's Syndrome

<h3>To the Editor.</h3> —On routine screening, we found that our adult patients with Down's syndrome had increased mean corpuscular volumes (MCVs), with normal hemoglobin values and hematocrits. Although first described in 1965,¹mention of the abnormality has been limited mostly to the European literature and has not been included in recent reviews.² <h3>Study.</h3> —Fifteen patients with clinically diagnosed Down's syndrome were eligible for study. A control population was composed of other mentally retarded participants who attended the same educational facility. Patients and control subjects were matched for institutionalized status, age, sex, race, and IQ. Each of the patients with Down's syndrome underwent a history and physical examination, a complete blood cell count, thyroid function tests, and measurement of serum B₁₂and folate levels. Intelligence quotient, diagnoses, pertinent history, and a complete blood cell count were collected for control subjects. The study population had a mean MCV of

Magnesium Stores and Anemia in Young Japanese Quail

Studies were conducted to determine the effect of age on magnesium requirement and whether high dietary magnesium during the first 7 days of life would protect against subsequent magnesium deficiency. Day-old Japanese quail were fed a casein-gelatin diet containing either 300 (requirement) or 600 ppm Mg. Beginning on day 7, half of the birds in each group received either 160 (deficient) or 300 ppm Mg. In birds fed the requirement level during week 1 followed by the deficient diet, hemoglobin decreased on day 10, reaching the lowest value on day 14. Other adverse effects included mortality; slightly reduced growth rate; elevated iron in the liver, spleen, and tibia; decreased tibia magnesium; and increased spleen weight. Higher dietary magnesium (600 ppm) during week 1 prevented deficiency when 160 ppm Mg was fed in week 2; however, tibia magnesium was lower than that in birds fed 300 ppm Mg throughout. The protection may be related to reutilization of skeletal magnesium, which was elevated on day 7. In this and another experiment, birds initially fed 300 ppm Mg followed by 160 ppm (7–28 days) or 125 ppm Mg (14–28 days) had normal hemoglobin values at 21 and 28 days. These experiments showed that magnesium requirement decreased as quail aged (up to 4 weeks) and that a high magnesium diet (600 ppm) fed through days 0–7 protected against subsequent dietary inadequacy.

Congenital erythrocytosis in the absence of detectable erythropoietin

IN CHILDREN erythrocytosis or polycythemia is most commonly a response to chronic arterial hypoxemia. Rarely, polycythemia is a primary congenital defect which in some instances may be familial? Such cases may be caused by high-affinity hemoglobin mutants or by unexplained erythropoietin overproduction in the absence of an identifiable cause of hypoxia. ~, 2 Recently there have been several reports of adults with a polycythemia vera-like disorder in which erythropoiesis appears to be autonomous or totally independent of erythropoietin. 3 We now describe a similar patient, a 9-year-ofd girl with congenital erythrocytosis, without detectable erythropoietin in her serum. CASE REPORT The patient had a hemoglobin concentration Of 14.9 gm/dl at 3 months of age. She was in good health throughout infancy and early childhood, and never required hospitalization. At 7 years of age she had a blood count done at the time of an upper respiratory infection and was found to have a hemoglobin of 18.7 gm/dl and hematocrit of 58%. She was referred to our institution for evaluation at 9 years of age. Careful review of symptoms was unremarkable except for fatigue and slight dyspnea with exertion during the previous two years. The family history was entirely negative for hematologic disorders. Consanguinity was not present and there were no siblings. The patient's father died of a myocardial infarct at age 42 years. Prior to his death he was documented to have a hemoglobin of 15.0 gm/dl and hematocrit of 45%. The patient's mother was in good health and fiad normal hemoglobin and hematocrit values. The physical examination was entirely within ~normal limits except for moderate plethora and a barely palpable spleen tip. Routine hematologic studies included multiple hematocrit determinations between 55 and 62% and hemoglobin measurements between 19 and 22 gm/dl. Reticulocyte counts ranged between 0.5 and 2.0%. The mean corpuscular volume was 82 ft. Her total and differential white blood cell counts and platelet counts were always normal. The following diagnostic laboratory studies were normal or negative: chest radiograph, intravenous pyelogram, pulmonary function tests, electrocardiogram, arterial blood gas values in room air and in 100% oxygen, hemoglobin electrophoresis on cellulose acetate (pH 8.6) and citrate agar (pH 6.3), fetal hemoglobin by the alkali denaturation method, serum iron and

Macrocytosis, Mild Anemia, and Delay in the Diagnosis of Pernicious Anemia

Various factors led to delays of several months to several years in the diagnosis of pernicious anemia in 11 patients, occasionally with serious consequences. These cases illustrate that earlier diagnosis is possible with closer attention to abnormal results of common tests. Macrocytosis, detected by high mean corpuscular volume, often preceded anemia but was not investigated, especially when anemia was only slight. Several cases demonstrated that vitamin B12 deficiency may initially produce only a mild macrocytic anemia, which is maintained for a long period before a rapid worsening supervenes; the reason for the latter acceleration of anemia is unknown. Most serious was the evidence that mild anemias are often ignored. Stricter attention to the established limits of normal hemoglobin values is required. These aspects of physician performance have implication for the recognition of all anemias.

Iron Sufficiency in Breast-Fed Infants and the Availability of Iron From Human Milk

Four infants were studied who had been exclusively breast-fed for periods varying from 8 to 18 months. All had grown sufficiently to have exhausted their prenatally acquired iron endowment with respect to meeting current needs for maintaining normal hemoglobin levels. All infants had normal hemoglobin values and normal serum iron values. Studies of iron absorption from breast milk and cow's milk were performed in ten normal adults. The absorption of iron from the human milk was significantly higher. These findings suggest that the iron present in human milk is sufficient to meet the iron requirements of the exclusively breast-fed infant until he approximately triples his birthweight.

Oxygen Affinity in Hemoglobin Köln Disease

Abstract Oxygen affinity studies in a splenectomized patient with sporadically occurring Hb Köln disease revealed high whole blood oxygen affinity (P50 O2 17.6 mm Hg) with increased 2, 3-diphosphoglycerate (DPG), low ATP, and normal RBC ΔpH. Isolated electrophoretically slow migrating Hb Köln had a high oxygen affinity, decreased Hill’s number, and normal DPG reactivity. Functional evidence for hybrid tetramers with normal mobility is presented. Partial deoxygenation may play a role in the denaturation of the Hb Köln molecule and thus account for a higher oxygen affinity (low P50 O2), measured by the mixing technique, than the actual values for P50 that exist in vivo. Increased oxygen affinity and decreased P50 O2 would result in increased erythropoiesis and account for a well-compensated hemolytic process in this patient with a normal red cell mass and normal values of hemoglobin.

Iron absorption and haemoglobin regeneration studies on a new sustained release iron preparation.

The effectiveness of a new sustained release oral iron preparation containing 100 mg of ferrous iron (Duroferon Duretter®) has been evaluated in. three separate studies.Study I. The absorption of iron was compared to the absorption from rapidly disintegrating ferrous sulphate tablets using a double radioiron technique. Dosage: 200 mg of ferrous iron daily.Study II. The haemoglobin regeneration rate was compared to the regeneration rate obtained with ordinary ferrous sulphate tablets in a cross‐over study in volunteers twice made anaemic and iron deficient by repeated phlebotomies. Dosage: 200 mg of ferrous iron daily.Study III. The haemoglobin regeneration rate was studied in a carefully selected homogeneous group of patients with iron deficiency anaemia. Dosage: 300 mg of ferrous iron daily.The absorption of iron from the sustained release tablets were significantly higher (mean 29 %) than from ordinary ferrous sulphate tablets. In the cross‐over study the haemoglobin regeneration rates obtained with the sustained release preparation were equivalent to that of ordinary ferrous sulphate tablets. All patients with iron deficiency anaemia reached normal haemoglobin values within. 7–10 weeks of treatment. The haemoglobin regeneration rates were the same as those found with optimal doses of oral and parenteral iron.

Post mortem chromosome analysis.

Chromosome studies were done on a total of 19 post mortem blood samples in order to determine how suitable post mortem blood would be for this purpose.Chromosome analysis can be successfully carried out if the sample of blood is taken less than 24 hours after death and sample has nearly normal hemoglobin and hematocrit values. However, it is more important that the sample should have a sufficient number of lymphocytes. This is generally found in blood samples with higher white counts.The perinatal group had 42% successful cultures whereas the adult group had 33%. This may be due to relatively high white count and higher lymphocyte count in perinatal cases. Incidentally, there were three cultures which showed a fibroblast-like cell growth in 72 hours.

Association of Laundry Starch and Clay Ingestion With Anemia in New York City

Nonpregnant patients in New York city had iron deficiency anemia and ate laundry starch or clay. Although this form of pica is common in the southern and western United States, it is less frequently considered in the northeast. Starch and clay ingestion varied from 250 to 1,300 gm/ day and average hemoglobin value was 6.2 gm/ 100 ml. All patients received iron but lack of cooperation allowed only three of ten patients to be followed up. They had normal hemoglobin values while continuing the ingestion of clay or starch. This suggests that the iron deficiency anemia in these adults was not a cause of pica but an effect. Cultural tradition or habit is probably another mechanism for this form of pica. Anemic, nonpregnant individuals should be questioned about pica, particularly clay or laundry starch ingestion.

Treatment of adult acute leukemia with arabinosylcytosine and thioguanine.

Forty unselected adults with acute leukemia were treated with CA (2–3 mg/kg) by daily rapid intravenous injection and TG (2.5 mg/kg) orally. Two patients were judged to have had an inadequate trial, having died after 3 and 4 days. Of 38 adequately treated patients, 2 had acute lymphoblastic and 36 acute myeloblastic, monoblastic, or myelomonoblastic leukemia. Twenty-eight patients had had previous chemotherapy (19 with either CA or 6-MP alone) but had failed to respond or had relapsed and were refractory. The 38 adequately treated patients had 1 or more courses of CA and TG of 8–32 days each as limited by individual tolerance. The drugs caused moderate or severe pancytopenia and marrow hypoplasia in all but 3 patients treated. Twenty-one of 38 patients had remission with M-1 marrows lasting an average 6 (1.5–13) months with 6 patients still in remission. Seventeen of 21 patients had H-1 peripheral blood ratings (normal platelet, leukocyte and hemoglobin values) and 4 had H-2 ratings, all because of low hemoglobin. Twenty patients in remission were given maintenance therapy; the dosage varied but is currently TG 2.5 mg/kg 4–5x/wk + CA 2–3 mg/kg 1-2x/wk.

The significance of anaemia in radiotherapy

Anaemia is of importance to the Radiotherapist in four ways. The importance of restoring normal haemoglobin values before starting radical radiotherapy is emphasised and it is suggested that in this instance transfusion is the correct measure. Anaemia may also be encountered during the course of a patient suffering from malignant disease; it should not be accepted as being due to the disease nor should transfusion be given until an attempt has been made to discover the cause. The significance of anaemia as a prognostic factor, particularly in the reticuloses, is stressed. Finally, radiotherapy may be used as a specific treatment for anaemia particularly in the patient suffering from hypersplenism. Anaemia is of importance to the Radiotherapist in four ways. The importance of restoring normal haemoglobin values before starting radical radiotherapy is emphasised and it is suggested that in this instance transfusion is the correct measure. Anaemia may also be encountered during the course of a patient suffering from malignant disease; it should not be accepted as being due to the disease nor should transfusion be given until an attempt has been made to discover the cause. The significance of anaemia as a prognostic factor, particularly in the reticuloses, is stressed. Finally, radiotherapy may be used as a specific treatment for anaemia particularly in the patient suffering from hypersplenism.

The readaptation of rats with altitude-induced polycythemia to sea level

AbstractRats were submitted to hypoxia corresponding to 6,000 m altitude for 40—50 days. The total amount of hemoglobin, blood volume and relative blood values had been studied in hypoxia and after transfer to normal oxygen pressure. Total hemoglobin increased during hypoxia by 150—200%, relative blood values by 100%, and blood volume by 25—50%, indicating the increase of oxygen capacity of the blood and the volume of the circulatory system. 30 days after transfer to normal oxygen pressure total hemoglobin, blood volume and relative blood values had returned to normal. Thereafter relative blood values showed a transient decrease, but not the total hemoglobin. Thus the blood volume increased again. Problems in connection with the homoistatic regulation of erythropoiesis have been discussed. The body weight decreased during hypoxia by about 15%. After the period of hypoxia was over the rate of increase in body weight was faster than that of animals of the same order and body weight.

HEMATOPOIESIS IN PREMATURE INFANTS WITH SPECIAL CONSIDERATION OF THE EFFECT OF IRON AND OF ANIMAL-PROTEIN FACTOR

Normal values in the first 3 months of life have been determined for hemoglobin, erythrocytes, reticulocytes, platelets, leukocytes and differential counts for premature infants with birth weights less than 1200 gm., and for those between 1200 and 1500 gm. at birth. No significant difference was found in the degree of depression of levels of hemoglobin and erythrocytes when values in the 2 weight groups were compared. Two reticulocyte peaks occur during the first 3 months of life. The first peak is present immediately after birth. The second peak, at about the eighth week, coincides with the occurrence of the greatest degree of anemia. Neither iron therapy nor treatment with animal-protein factor containing vitamin B12 and Aureomycin®, started before the end of the third week of life, had a statistically significant effect on the early phase of the anemia of prematurity. Untreated premature infants and those given animal-protein factor were anemic at the end of the first year of life. Subjects given iron therapy had normal hemoglobin values at one year of age. Blood transfusion is rarely necessary in the treatment of the anemia of prematurity.

Blood Hemoglobin Values of Dairy Cattle

The blood hemoglobin value of dairy cattle has been used as an index of the nutritional status of an animal with respect to iron, copper and cobalt. The literature is somewhat conflicting as to what constitutes a normal blood hemoglobin value for dairy cattle. Dukes (1) reports 12.2 g. hemoglobin per 100 ml. of blood as the normal hemoglobin value of the bovine species, whereas McCay (6) regards 10.9 g. as normal. Much of the conflicting evidence may be due in part to the many and varied methods of analysis. Many types of optical instruments have been used with variable results. Chemical analyses have not been too reliable. Inasmuch as difficulty is encountered in interpreting the literature with respect to a normal blood hemoglobin, additional data are desirable. In connection with mineral studies of the Oregon Agricultural Experiment Station, the blood hemoglobin value has been used as an index of the iron, copper and cobalt status of dairy cattle throughout the state. This study reports the results of hemoglobin values obtained under various conditions.

Follicular lymphoma with transient leukemic phase; brief review of literature and report of a case.

ABRIEF review of the literature on blood changes in follicular lymphoma disclosed that in the cases reported by Brill, Baehr, and Rosenthal 1 the blood picture was normal. The majority of later cases also appeared to be associated with normal red blood cell count and hemoglobin values. Sometimes slight anemia was observed. 2 According to Gall and associates, 3 anemia (a count of 3,500,000 red blood cells or less) was found in 18% of their 63 follicular lymphoma cases, compared with an incidence of 39% in their cases of other lymphomas. They frequently noted anemia as a terminal manifestation, perhaps due to long-continued irradiation. Meyer 4 reported marked anemia in one of six cases; moderate anemia in two, and no anemia in three cases. Mayer and Thomas 5 found terminal normocytic anemia in all their cases. The anemia was severe in only two cases. One patient, with normal results on bone marrow study, reacted well