Paleontologic Thalassemia

Perspectives on anemia: Factors confounding understanding of past occurrence

OBJECTIVE

This paper reviews factors confounding the understanding of the past occurrence of anemia. Using the evidence gathered, a framework is presented of ways forward to enable greater confidence in diagnosing acquired anemia in paleopathology, facilitating insights into longer-term perspectives on this globally relevant condition.

RESULTS

To date, porotic lesions have been central to paleopathological investigations of anemia. The fact that porotic bone lesions are omnipresent and have multiple causes but are likely to have a relatively low, age-related frequency in individuals with anemia, a condition that will have been common in past communities, is confounding.

METHODS

Establishing frameworks that move away from porotic lesions is proposed to facilitate higher levels of more accurate anemia diagnoses in paleopathology.

SIGNIFICANCE

Acceptance of the fundamental principle that anemia may be better considered as a condition requiring metric evaluation of bone structures, supplemented by careful consideration of lesions, will advance understanding of acquired anemia in past communities. Such an approach would provide a clear basis for further consideration of congenital conditions causing anemia, such as sickle-cell disease and thalassemia.

LIMITATIONS

This paper simply opens the conversation on the better diagnosis of anemia in paleopathology; it starts the iterative process of achieving some consensus and progress on diagnosing anemia in paleopathology.

SUGGESTIONS FOR FURTHER RESEARCH

Engagement with ideas presented, sharing data and development of metric parameters will assist in identifying the effects of marrow hyperplasia on bone, enabling more robust work on the important topic of anemia.

L'hypérostose poreuse du crâne, les anémies héréditaires et le paludisme en Grèce

De prime abord on pourrait s'étonner de trouver réunis sous un seul titre des états pathologiques aussi disparates qu'une modification morphologique particulière des crânes anciens, un groupe d'anomalies héréditaires du sang et une fièvre d'origine parasitaire. Ce rapprochement n'est point fortuit : l'étude de chacun des volets de ce triptyque médico-historique peut éclairer singulièrement les deux autres.

On pourrait s'étonner également de voir figurer cet article dans un ensemble de textes consacrés à l'Histoire des Sciences, car on s'aperçoit d'emblée que son objet n'est point la pensée scientifique d'antan. Il s'agit pourtant d'un essai qui relève essentiellement de cette discipline dans la mesure où elle est le lieu privilégié de rencontre des recherches scientifiques (au sens restreint) et des études historiques. Le domaine d'une investigation se définit au moins autant par les méthodes utilisées que par l'objet examiné.

Cribra orbitalia in the ancient Nile Valley and its connection to malaria

Cribra orbitalia is a common skeletal lesion found on ancient human remains excavated from the Nile Valley. Recent etiological research implicates hemolytic anemia as a main factor leading to the formation of cribra orbitalia. Further, an association between the hemolytic anemia caused by malaria and cribra orbitalia has been demonstrated. The presence of malaria in the ancient Nile Valley has been verified directly through genetic and immunologic studies of Egyptian mummies, but its prevalence and spread remain unknown. As some models have pointed to the Nile Valley as the pathway of malarial dispersion during the Egyptian Dynastic period, variability in cribra orbitalia rates should provide a way to track the disease spread. This study surveyed cribra orbitalia frequencies at 29 ancient Nile Valley sites, representing 4760 individuals ranging from prehistoric to Christian periods and situated between the 3rd Cataract and Nile Delta. Results showed high cribra orbitalia rates, with an overall mean of 42.8% of the total population affected. Over time and space, the data showed no significant correlation, suggesting high levels of anemia affected individuals in the Nile Valley equally from late pre-dynastic to Christian periods. These findings suggest widespread endemic malaria in the Nile Valley before Dynastic Egypt.

The ABO blood group system and Plasmodium falciparum malaria

In the century since the discovery of the ABO blood groups, numerous associations between ABO groups and disease have been noted. However, the selection pressures defining the ABO distributions remain uncertain. We review published information on Plasmodium falciparum infection and ABO blood groups. DNA sequence information dates the emergence and development of the group O allele to a period of evolution before human migration out of Africa, concomitant with P falciparum's activity. The current geographic distribution of group O is also consistent with a selection pressure by P falciparum in favor of group O individuals in malaria-endemic regions. We critically review clinical reports of ABO and P falciparum infection, documenting a correlation between disease severity and ABO group. Finally, we review published data on the pathogenesis of P falciparum infection, and propose a biologic model to summarize the role of ABO blood groups in cytoadherence biology. Such ABO-related mechanisms also point to a new hypothesis to account for selection of the Le(a-b-) phenotype. Taken together, a broad range of available evidence suggests that the origin, distribution, and relative proportion of ABO blood groups in humans may have been directly influenced by selective genetic pressure from P falciparum infection.

Cranial thickening in an Australian hominid as a possible palaeoepidemiological indicator

This paper describes the cranial thickening of a late Pleistocene hominid (Willandra Lakes Hominid 50) from Australia. The unusual development of the vault structures in this individual has few, if any, equals among other hominids or more recent populations from around the world. The vault morphology is, therefore, described in terms of a pathologically related condition associated with the modern haemolytic blood dyscrasias, typical of sickle cell anamia and thalassemia. A possible palaeoepidemiology for these genetic adaptations among early Australasian populations is proposed together with a discussion of similar changes observed in the vault of the Singa calvarium from the Sudan. It is tentatively suggested that the cranial thickening of the Australian hominid has its origins in some form of genetic blood disease and that if this diagnosis is correct, this individual provides a rare glimpse of human biological adaptation in the late Upper Pleistocene.

Cribra orbitalia in the aborigines of Hawaii and Australia

Cranii of 53 Hawaiian aboriginal infants and children, and 45 from Austrailian aboriginal children were inspected. Cribra orbitalia was present in 22.8% of the former and 26.6% of the latter; osteoporotic pitting (symmetrical osteoporosis; porotic hyperostosis) was also present in the latter. The frequency compares favorably with that found in pre-Columbian North American Pueblo Indians, 24.7%. It is associated with a widespread skeletal involvement suggestive of an active bone marrow. The findings support the concept that cribra orbitalia is related to symmetrical osteoporosis and that it may be associated with a blood disorder.