The relation of the isoagglutinins in pooled plasma to the haemolytic anaemia of burns

Patients showing red cell loss following severe burns have been considered in two groups, the more severe cases with late haemoglobinuria and the more numerous less severe cases without late haemoglobinuria. Patients who had late haemoglobinuria usually belonged to group A or AB, showed a normal or increased osmotic fragility of red cells, and had received more than three plasma volumes of pooled plasma. It is suggested that this haemolytic anaemia may have been caused by the anti-A isoagglutinins in pooled plasma or serum. Patients showing red cell loss but who had no late haemoglobinuria had a normal ABO group distribution and an increased osmotic resistance of their red cells. It is concluded that this more common type of red cell loss in burns is independent of transfused isoagglutinins. Isoantibodies present in pooled plasma have been investigated. Corresponding antibodies have been demonstrated in the serum of groups A and AB patients transfused with moderate quantities of pooled plasma. The same patients commonly also had a raised erythrocyte sedimentation rate, without there being a clinically important red cell loss.

HAEMOLYTIC ANAEMIA IN HODGKIN'S DISEASE ASSOCIATED WITH IMMUNOGLOBULIN DEFICIENCIES

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EFFECT OF HEMOLYSIS ON EXCRETION AND ACCUMULATION OF IRON IN THE RAT

Two groups of rats were injected intraperitoneally with tracer amounts of Fe59 Cl3 and the rate of loss of radioactivity was measured over a period of 105 days. Both groups of rats were maintained on a regular rat pellet diet but the experimental group also received acetylphenylhydrazine weekly in order to induce hemolytic disease. At the end of the experiment all rats were killed and the body iron content of each determined. It was observed that the fraction of body iron lost daily was markedly increased in rats undergoing hemolysis. Further, these rats accumulated iron in excess of normal, indicating that iron absorption was increased to a greater extent than was iron excretion.

DIFFERENTIAL FERRIOXAMINE TEST FOR MEASURING CHELATABLE BODY IRON

The differential ferrioxamine test is a simple method for the measurement of chelation of body iron by desferrioxamine. A single six-hour specimen of urine is obtained after intravenous Desferal, accompanied by (59)Fe-ferrioxamine. Two values are measured: F(d), the excretion of ferrioxamine derived from body iron by chelation, and F(ex), the proportion of ferrioxamine excreted from a known intravenous dose. The data enables F(v), chelation of iron in vivo, to be calculated by simple proportion. Desferrioxamine chelation proceeds for about half an hour after injection. The results in normal subjects, in cases with known high iron stores, and in cases of iron-deficiency anaemia are described. High, normal, and low body iron states have been differentiated. F(v) values in the higher ranges obtained in iron-storage diseases and in haemolytic states are differentiated by the pattern of excretion, high F(d) values and low F(ex) values respectively. IT IS SUGGESTED THAT THERE ARE TWO MAIN SOURCES OF CHELATABLE BODY IRON: as ferritin-haemosiderin and as iron newly released from haem in a more readily chelatable form. The significance of variable chelation susceptibility in iron metabolism is briefly discussed. It is suggested that variable chelatability of different sources of body iron may explain the preferential utilization of iron released from red cells or absorbed from the intestine, rather than storage iron, in the biosynthesis of haem.