Anaemia in a Country Practice

Gregor, William McLeod (1955) Anaemia in a Country Practice. PhD thesis, University of Glasgow.

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My experiences in the diagnosis and treatment of anaemia in general practice have been described. Daring the eight year period, 1944-52, I encountered 157 cases of iron deficiency anaemia and 15 cases of macrocytic anaemia. The macrocytic anaemias consisted of 9 patients with pernicious anaemia, 2 with myxoedema, 1 with a leuco-erythroblastic anaemia which was probably due to malignant disease, and 1 whose anaemia was associated with pemphigus foliaceus. Because of the varying degrees of macrocytosis seen in blood films, I occasionally experienced difficulty in deciding whether or not there was sufficient evidence to justify the label of "macrocytic anaemia". Only when macrocytosis was pronounced, could this diagnosis be made with confidence. This uncertainty would not have arisen if the state of bone marrow erythropoiesis had been known. One of the 9 patients with pernicious anaemia developed cancer of the stomach after 10 year's treatment with liver. The relationship between pernicious anaemia and cancer of the stomach should always be kept in mind. In the treatment of pernicious anaemia, considerable difficulty was experienced in achieving and maintaining a red cell count of over 4 million per c. mm. In the 157 iron deficiency anaemias, there occurred only 2 cases of Plummer-Vinson Syndrome. The "idiopathic" hypochromic anaemia of menstruating women was the most common type of anaemia encountered during the eight year period. No case of ''idiopathic" hypochromic anaemia was seen in 27 men with anaemia. Anaemia of pregnancy was comparatively rare, there being only 7 cases detected showing obvious anaemia, in approximately 296 pregnancies. This was probably due to prophylactic administration of iron to every pregnant woman. No case of macrocytic anaemia of pregnancy was seen. In a number of anaemic women who had passed the menopause, there was no obvious explanation of the anaemia. A diet lacking in iron, and impaired absorption of iron from the bowel were possible etiological factors in these cases. In the treatment of iron deficiency anaemias, it was important to observe the response of the haemoglobin. A sluggish response of the haemoglobin level to iron therapy was sometimes the first indication of the presence of serious latent disease. This was of particular importance in the early diagnosis of cancer of the stomach. Cancer and tuberculosis were the most common, causes of secondary anaemia. Gastro-intestinal haemorrhage was also a frequent source of anaemia, and the detection of occult bleeding in the faeces was of great assistance on several occasions in explaining a severe anaemia. Anaemia was detected in a number of patients with valvular disease of the heart. The administration of iron to correct anaemia helped these patients considerably and justifies a routine blood count in all patients with heart disease. Three patients with leukemia and one with splenic anaemia were seen in the eight year period. A number of miscellaneous diseases associated with anaemia were encountered and have been included in this report. Among them were two unusual cases of osteosclerosis. The diagnosis of "marble-bone" disease has been made in one of these patients and a follow-up investigation of her family has shown the condition to be present in three generations of that family and in two generations of a related family. What appeared to be a hereditary tendency to idiopathic hypochromic anaemia and menopausal haemorrhage was seen in two separate families, and one example occurred of pernicious anaemia and idiopathic hypochromic anaemia in members of the same family.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Medicine
Date of Award: 1955
Depositing User: Enlighten Team
Unique ID: glathesis:1955-79133
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 05 Mar 2020 11:40
Last Modified: 05 Mar 2020 11:40

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