Annual report / Medical Department, Fiji.

  • Fiji. Medical Department.
Date:
[1949]
Catalogue details

Licence: Public Domain Mark

Credit: Annual report / Medical Department, Fiji. Source: Wellcome Collection.

    24/38 (page 24)
    APPENDIX IV. AN INVESTIGATION INTO ANAEMIA AT MAKOGAI LEPROSARIUM. Sulphetrone has been used at Makogai for the treatment of all cases of lepromatous leprosy for six months: up until six weeks ago all cases receiving sulphetrone have been given Ferri et Ammon Cit by mouth. No yeast has been administered. A mild anaemia was noticed and on May 21st, 1949, I proceeded to Makogai to investigate this anaemia. Previous work on Sulphetrone therapy.—Brownlee (1948) found in rabbits that prolonged sulphetrone administration caused three types of anaemia—- (1) a Haemolytic anaemia with a concurrent reticulocytosis; (2) a progressive anaemia due to lack of iron owing to competition for alimentary iron by sulphetrone which forms a non-absorbable iron compound. ; (3) an anaemia of slower development but precipitate onset which could be prevented by Brewers’ yeast, probably caused as he thought by an alteration in the bacterial flora of the gut. He investigated 11 tuberculous human patients who were receiving sulphetrone and found anaemia.' The marrow of these patients showed an increase in primitive red cells but no megalo- blasts were found. Madigan (1948) found secondary anaemia in tuberculous patients receiving sulphetrone and recommended both iron and yeast for the prevention of this anaemia. However he stated that the tuberculous patients in general were poorly nourished. Davey (1948) noted a hypochromic anaemia developing in 15 out of 17 cases of Leprosy under treatment with sulphetrone. The anaemia was not very severe, the haemoglobin remaining in the region of 60 per cent. Wharton (1948) noted mild anaemia in all cases of leprosy he treated with sulphetrone and recommended ferrous sulphate 5 grs. three times daily. Muir (1948) stated that the anaemia developing in leprosy under treatment with sulphetrone had not been fully investigated but recommended the administration of iron and injections of liver. Present position at Makogai.—For the last six to seven months 450 lepromatous patients at Makogai have been treated with sulphetrone 3 grammes daily. For six weeks no iron has been administered and a few patients were noticed to be slightly anaemic as estimated by the Tallquist method. Twenty cases of lepromatous leprosy who were thought to be most affected were investi¬ gated fully as to the state of their blood and marrow. Fourteen of these cases were taking 3 grammes of sulphetrone daily, and six had been taking 3 grammes daily until one month before investigation when they were given 6 grammes daily. All had had iron and ammonium citrate up until six weeks before investigation. None had had any yeast or liver preparations. Eight cases of Tuber¬ culoid leprosy who had had no sulphetrone were examined in the same way as controls. Results of the Investigation.—Examination of the figures for haemoglobin, mean corpuscular volume, mean haemoglobin concentration, and red cell count revealed that the anaemia was mild and was microcytic and normochromic. Examination of the marrow smears showed no megalo- blasts and no evidence of any maturation defect such as would be produced by a lack of the haemo- poietic liver factor. Only one case showed any evidence for haemolysis with an Icteric Index of 20 and a serum bilirubin of 1-25 mgms. per cent; in this case there was no reticulocytosis. Only one case showed hookworm infestation. Further work being carried out at Makogai.—Full haematological studies on these patients are continuing in the laboratory on Makogai. All the 20 cases are being kept under observation and the result of administration of iron is being watched. All the 450 cases of leprosy under treatment with sulphetrone will receive 30 grains of ferrous sulphate daily until this dose can be reduced if observation of the above patients suggests that the dose can be reduced. No yeast will be administered. Sample blood studies of the rest of the 450 patients to see if any become anaemic are being undertaken. Discussion.—The mild anaemia which has so far developed at Makogai would appear to be a microcytic normochromic anaemia. However some of the cases are hypochromic and if a larger series were studied no doubt the mean haemoglobin concentration would be less than in the controls. The absence of any evidence for liver deficiency could be due to the excellent diet and living condi¬ tions present on Makogai. Yeast has been recommended and found to be necessary in tuberculous patients who as Madigan (1948) states in general were poorly nourished; there is no evidence in any clinical work of the development of an anaemia with megaloblasts in the marrow as a result of sulphetrone administration. It would be unjustifiable at present therefore to give yeast daily to all the 450 patients at Makogai undergoing treatment with sulphetrone as this would be a very heavy expense. Future work as laid down above will show the necessity in future for any change in this policy. REFERENCES. Brownlee, G., Lancet, July 24, 1948, pp 131-134. Davey, T. F., April, 1948, Leprosy Review, pp 55-61. Muir, E., March, 1948, Transactions Roy. Soc. Trop. Med. & Hyg. pp. 575-582. Wharton, L. H., April, 1948, Leprosy Review, pp. 71-75. Madigan, D. G., Lancet, July 31st, 1948, pp. 174-179.