Plasma and red cell iron turnover in protein calorie malnutrition

Ultrastructure and cell cycle distribution of bone marrow cells in protein-energy malnutrition

Bone marrow aspirates from four children with kwashiorkor and three with marasmus were studied using the techniques of electron microscopy and combined Feulgen microspectrophotometry and 3H-thymidine autoradiography. The majority of the erythroblasts were ultrastructurally normal, the distribution of the early polychromatic erythroblasts between the various stages of the cell cycle was normal or almost normal, and the macrophages did not contain ingested erythroblasts. Since erythropoietin production has been shown to be normal in protein-energy malnutrition, these findings suggest that at least in some cases of PEM the impairment of erythropoiesis results primarily from an abnormality in the erythroid progenitor cell pool rather than from dyserythropoiesis and ineffective erythropoiesis. In one afebrile and apparently uninfected patient with marasmus, a substantial proportion of the neutrophil granulocytes and their more mature precursors contained electron-dense, myelin-containing intracytoplasmic structures which were presumed to be abnormal primary granules. In four of the patients, the 3H-thymidine labelling index of the neutrophil promyelocyte-myelocyte pool was increased. In addition, in all of the cases, neutrophils at various stages of degradation were readily found within the cytoplasm of some of the macrophages. Thus, whereas the techniques employed did not reveal a major disturbance in the morphologically recognizable precursor cells of the erythroid series in PEM, they demonstrated some abnormalities in such cells of the neutrophil series.

Serum and red cell folates, and serum vitamin B 12 in protein calorie malnutrition

In 22 cases of kwashiorkor, 19 cases of marasmus, and 16 normal controls, red cell folate, serum folate, and serum vitamin B₁₂ were estimated, and the bone marrow and peripheral blood examined. Erythrocyte folate deficiency was shown in 9 cases of kwashiorkor and 7 cases of marasmus. Serum folate deficiency was present in 14 cases of kwashiorkor and 7 cases of marasmus. Megaloblastosis was found in 45% of cases of kwashiorkor and 37% of cases of marasmus. Megaloblastosis and macrocytosis correlated more with erythrocyte than with serum folate deficiency. Serum vitamin B₁₂ levels in children with kwashiorkor or marasmus did not differ from those of normal controls. The role of folate deficiency in the pathogenesis of megaloblastosis in protein calorie malnutrition was confirmed.