Studies of the Incidence, Etiology and Morphogenesis of the Anaemias of Pregnancy

Neville, Jean M (1948) Studies of the Incidence, Etiology and Morphogenesis of the Anaemias of Pregnancy. MD thesis, University of Glasgow.

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(1) 48 patients all with severe anaemia have been followed throughout pregnancy, repeated marrow punctures being performed where possible. A further 74 were seen at regular intervals and biochemical and haematological findings were recorded as for the first group. A remainder of 35 patients with severe anaemia were seen just before delivery and could be followed only in the puerperium. The survey therefore includes 148 patients with severe anaemia. (2) Eight cases of typical pernicious anaemia of pregnancy were diagnosed. Six of these presented the usual blood picture when first seen, but, in two cases, the peripheral blood picture was originally that of a severe iron deficiency anaemia and the features of pernicious anaemia of pregnancy developed only at a later date. The changes in the peripheral blood in all of these cases were similar to those of Addisonian pernicious anaemia, namely - macrocytosis, hyperchromia, anisocytosis, poikilocytosis, a low reticulocyte count and a normal fragility. The plasma proteins were low and, in the two cases, who originally appeared to be severe iron deficiency anaemias, the plasma was jaundiced. Morphologically the marrow was dimorphic, numerous smear cells were present and the degree of haemoglobinisation of the late normoblasts and megaloblasts was marked. The megaloblast percentage was high, the normoblast low, and the percentage of reticulated cells in untreated cases was low. The response to liver and folic acid therapy in these cases has been described and the effect of substituting iron for liver therapy has been observed in the partially treated cases. (3) Gases of atypical pernicious anaemia of pregnancy are much more common. Altogether 27 cases were proved to belong to this group, 24 by sternal puncture, and 3 by therapeutic tests. Clinically these cases can be divided into three groups, namely anaemias, anaemias and toxaemia characterised by low plasma proteins, and anaemia and jaundice characterised by the development of a sub-clinical jaundice in the course of therapy. The peripheral blood picture in these three groups is essentially the same and cannot be differentiated from that of the iron deficiency anaemias. An initial diagnosis in these cases depends on the bone marrow picture, which shows approximately 2% megaloblasts and 20% normoblasts. The latter figure, which is intermediate between that of the iron deficiency anaemias and the cases of typical pernicious anaemia of pregnancy, is the more significant. The response to iron therapy is the same in each group. Originally satisfactory, it levels out, giving a typical plateau curve beyond which no improvement will occur on iron therapy alone. The effect of various treatments in each group has been discussed with reference to the aetiological factors and it has so far been found that equally good results were obtained by treating the obvious deficiency as by giving liver or folic acid empirically. The importance of gastro-intestinal upset as a factor in this type of anaemia has been stressed and results in accordance with those noted in previous sections have been obtained. (4) The remainder of the patients investigated before delivery have been regarded as iron dexiciency anaemias. It has been shown, however, that many of these patients may have megaloblasts in their bone marrow and from these findings it has been concluded that megaloblasts occurring in the marrows of cases with a severe microcytic hypochromic anaemia of pregnancy have not the significance of the megaloblasts seen in the marrows of non-pregnant patients. Instead, the significant feature appears to be the percentage of normoblasts, if this is more than 30% initially, the anaemia will respond satisfactorily to iron therapy, if necessarily after admission to hospital or with the administration of acid hydrochlor. dil. in addition to the iron. The marrow picture in these cases appears to be active, reticulated cells are numerous both before and after iron therapy, and, in the second smear taken when the blood levels are normal, the percentage of megaloblasts has decreased while the normoblasts remain unchanged. Biochemically the plasma proteins are low, but not as low as in the atypical cases of pernicious anaemia of pregnancy. The Van den Bergh is negative and the cases which showed urobilinogenuria originally, clear up as a result of iron therapy. (Abstract shortened by ProQuest.).

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine, Obstetrics
Date of Award: 1948
Depositing User: Enlighten Team
Unique ID: glathesis:1948-79676
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 31 Mar 2020 09:09
Last Modified: 31 Mar 2020 09:09

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