Problems of anaemia in general practice: the clinical findings and blood pictures in 86 patients, with special reference to hypochromic anaemia in women of the reproductive period

Abstract

#1. The observations on which this thesis is based were made by me in the course of routine duties as an assistant in general practice.

#2. A description of the type of practice is given and of the method of selection of cases for examination.

#3. The desirability of performing blood counts as a routine diagnostic measure in general practice is urged.

#4. The normal figures for haemoglobin and red blood corpuscles are stated.

#5. The various methods by which the percentage of circulating haemoglöbin in healthy blood is calculated, are described in some detail.

#6. The Haldane scale is defined.

#7. The necessity for standardisation of all haemoglobinometers in terms of absolute values is stressed.

#8. The reasons for rejecting the uncorrected figures given by my Sahli Haemoglobinometer are stated.

#9. The standardisation of my Haemoglobinometer is described.

#10. The phenomenon of the increasing depth of colour in a newly prepared sßlution of acid haematin is described.

#11. Figures obtained from an investigation of this phenomenon are used to establish a method for the quick conversion of readings on the Sahli Haemoglobinometer into percentages on the Haldane scale.

#12. The principle of the diffraction method of measur :ing the mean red cell diameter is described and its limitations outlined.

#13. My experience with an instrument of this type are given.

#14. The case notes of 86 patients observed over a period of 1* years in general practice, are given together with the blood picture, treatment, and progress notes.

#15. Three cases of pernicious anaemia observed in hospital are added.

#16. The clinical classification of 68 cases of anaemi in general practice is given. The cases fall int the following groups, according to age: 1. Children 14 cases; 2. Adolescents 1 case; 3. Adult males 7 cases; 4. Adult females 46 cases.

The cliñical subdivision of these groups reveal the following:- Hypochromic anaemia in children 14 cases; Hypochromic anaemia in adolescents., 1 case; Pernicious anaemia 4 case;: Hypochromic anaemia in adult males 5 case;; Hypochromic anaemia in females 44 cases; Total....68 cases.

#17. When cases of pernicious anaemia and cases with a demonstrable organic basis are excluded, only 33 cases of idiopathic hypochromic anaemia remain. Of these 30 occurred in adult females, and 3 in children.

#18. It is therefore concluded that an idiopathic hypochromic anaemia in which no underlying pathology is found is common only in children and females.

#19. 26 of the cases of idiopathic anaemia in adult females are discussed as a whole.

#20. The importance of dietary deficiency and iron los due to menstruation are stressed.

#21. The high incidence of the condition in the re- productive period, and especially towards the menopause is stressed.

#22. The role of repeated pregnancies in the aetiology of hypochromic anaemia is minimised.

#23. The symptomatology is discussed and the incidence of glossitis, dysphagia, koilonychia, dyspepsia, amenorrhoea, and menorrhagia are noted: 1. In relation to the total number of cases (26); 2. In relation to the degree of anaemia present.

#24. The response to treatment is indicated.

#25. The other hypochromic anaemias found in adult females are very briefly noted under appropriate headings.

#26. Seven cases of pernicious anaemia are discussed.

#27. Two cases of hyperpoiesis associated with pernicious anaemia are described.

#28. The financial aspect of pernicious anaemia is stressed, and the average weekly cost of maintenance of the seven cases are noted in detail.

#29. It is shown that parenteral injection is a cheaper method of therapy than the exhibition of raw liver orally.

#30. It is suggested that Anahaemin is a cheaper and more efficient liver extract than Campolon.

#31. cases of hypochromic anaemia occurring in adult males are briefly noted under appropriate headings.

#32. Fourteen cases of hypochromic anaemia in children are discussed as a whole. The associated pathological lesions are noted.

#33. The importance of thorough examination of anaemic children in order to discover the underlying pathology, is illustrated.