American Journal of Clinical Nutrition, Vol 18, 116-122, Copyright © 1966 by The American Society for Clinical Nutrition, Inc.

Studies of the Pathogenesis of a Tropical Normocytic Anemia

¹ From the United States Operation Mission to Peru and the Ministry of Public Health, Lima, Peru

A study was made of the effect of therapeutic doses of iron (200 mg. elemental iron per day), anthelminthic therapy and protein supplementation on the anemic condition of sixty-five Amazon Basin schoolchildren. In 80 per cent of the children initial hemoglobin levels were below 10 gm. per 100 ml. The anemia was normocytic and normoblastic. All the children eliminated Uncinaria, 79 per cent Ascaris and 64 per cent Trichuris. Strongyloides larva were found in 64 per cent of the subjects.

Therapeutic doses of iron significantly (P < 0.05) increased hemoglobin, hematocrit and red blood cell levels, but no more so than small doses (5 to 50 mg. elemental iron per day) which are in the range of public health programs. The increase in hematologic values obtained when anthelminthics were combined with therapeutic doses of iron was significantly greater (P < 0.05) than that in the group given iron therapy alone. After six weeks of iron therapy, a protein supplement was given for six weeks with and without the same daily iron dosage. There were no significant (P > 0.05) changes when the protein supplement was given after iron therapy.

A combination of therapeutic doses of iron, effective anthelminthic therapy and dietary protein supplementation was not successful in attaining normal hematologic values.

The results of this study suggest that whereas infestation has an important role in the pathogenesis of this anemia, there are additional factors responsible for the normocytic condition which are probably related to chronic infection.