THE THALASSAEMIA TRAIT IN AN ENGLISH FAMILY

Nine cases of the thalassaemia trait are described in an English family. The problem of distinguishing these cases from those of the common hypochromic anaemias by simple laboratory tests is discussed.Iron-resistant hypochromic anaemia in people of British ancestry may be caused by the thalassaemia trait. Such cases have been reported by Bywaters (1938), Israëls, Suderman, and Hoogstraten (1955), Israëls and Turner (1955), and Havard, Lehmann, and Bodley Scott (1958). Dacie (1960) mentions similar cases and Callender, Mallet, and Lehmann (1961) recently described the finding of 25 cases in three English families.

HAEMOLYTIC ANAEMIA IN HODGKIN'S DISEASE ASSOCIATED WITH IMMUNOGLOBULIN DEFICIENCIES

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THALASSAEMIA IN SCOTS

Five cases of thalassaemia minor and 11 symptomless trait carriers have been detected in four Scottish families, only one of which is known to have foreign ancestry. It is suggested that the condition is commoner than was once thought, and that the diagnosis should be considered in any patient with refractory hypochromic anaemia in which the red cells show increased osmotic resistance.

HEMODYNAMIC EFFECTS OF CHRONIC SEVERE ANEMIA

Data on the cardiac output and circulatory dynamics obtained by cardiac catheter studies in 51 subjects with chronic severe anemia are presented. Patients are divided into two groups: group A consists of 26 subjects with an average hemoglobin value of 3.0 Gm. per 100 ml. (range 1.5 to 3.8 Gm.); group B, 25 patients with a hemoglobin level of 4.0 to 6.5 Gm., average 4.5 Gm.

Group A subjects have a somewhat faster heart rate (99 against 92 a minute), higher cardiac index (8.0 versus 6.3 liters per minute per square meter), and stroke index (88 and 68 ml. per beat per square meter) than group B patients.

The oxygen consumption values in both groups are normal (average 158 and 160 ml. per minute per square meter), while more oxygen is extracted by the tissue in group A subjects (61 and 53 per cent) whereas less oxygen is transported to the tissue (261 and 321 ml. per minute per square meter).

The stroke volume seems to bear a closer relationship to the high cardiac output than such other parameters as heart rate, right heart filling pressure, and velocity of blood flow. Apparently the presence of slow heart rate does not negate high cardiac output.

Data also suggest that systemic vascular resistance may play an important role in the high cardiac output as the two are inversely related, and by increasing the peripheral arterial pressure the output can be significantly reduced.

Restudy data after the treatment of the anemia (hemoglobin 10.0 to 12.5 Gm. per 100 ml.) show appreciable reduction in the cardiac output and in the right heart filling pressure, increase in the peripheral vascular resistance and oxygen transport values, and widening of the arteriovenous oxygen differences with concomitant decrease in the oxygen extraction by the tissue.

METHOD USING ORTHO-TOLIDINE FOR THE QUANTITATIVE DETERMINATION OF HAEMOGLOBIN IN SERUM AND URINE

Following a study of the spectrophotometric properties of ortho-tolidine and its oxidation products, with particular attention to variation brought about by change in the hydrogen ion concentration, a method for the quantitative estimation of haemoglobin in serum and urine in which ortho-tolidine is substituted for benzidine in a peroxidase system is described. The method is designed to measure haemoglobin value within the range 0-125 mg. per 100 ml. Evidence is presented showing that it gives results equal in accuracy and reproducibility to a benzidine method in common use and for reasons stated is a more satisfactory technique for estimating the haemoglobin content of urine.