Edward R. Eichner

Splenic function: Normal, too much and too little

This review is concerned with normal splenic function, mechanisms and consequences of splenomegaly, hypersplenism, the medical indications for splenectomy and the various aspects of hyposplenism. The potential probelm of lethal septicemia in hyposplenic or asplenic patients is also considered.

Effect of Alcohol on Serum Folate Level

Alcohol was given orally and intravenously to normal and chronic alcoholic volunteers to study its effect on folate metabolism. Oral alcohol, given to nine subjects on a low folate diet, caused a greater fall in serum Lactobacillus casei folate levels than that seen in eight subjects on a low folate diet alone. This alcohol-induced fall in serum folate level occurred largely during the 1st day of the protocol. Although brief infusions of intravenous ethanol had no effect on serum folate level, a 13 h infusion caused a striking fall in serum folate level between the 8th and 10th h. When ethanol was stopped, the serum folate level returned rapidly to normal. Two chronic alcoholic subjects with different basal levels of serum folate were studied for several weeks on a low folate diet plus alcohol. The serum folate level fell promptly in each subject, rose when alcohol was temporarily stopped, and fell when alcohol was resumed. Folate-deficient megaloblastic anemia developed in 3 wk in the subject with initially marginal serum folate levels, but failed to develop in almost 7 wk in the subject with normal folate stores, as reflected by initially high serum folate levels. Thus, the alcohol-induced fall in serum folate level was apparently not a result of depletion of folate stores. In vitro experiments ruled out an assay artifact as an explanation for the alcohol-induced fall in serum L. casei folate level. It seems likely that alcohol interferes with the delivery of n-5-methyltetrahydrofolic acid from storage areas.

The hematologic disorders of alcoholism

Abstract Alcoholism is associated with abnormalities of the red cells, platelets and white cells. These hematologic disorders of alcoholism are considered herein. The section on red cells deals with abnormalities of folate and iron metabolism; marrow erythroid disorders, including the ring sideroblasts seen in alcoholic patients; and the hemolytic anemias associated with stomatocytosis, acanthocytosis and Zieves syndrome. The section on platelets reviews the literature on the incidence and pathogenesis of thrombocytopenia in alcoholic patients. Finally, the section on white cells considers the alcohol-related disorders of leukocyte kinetics and function.

Variations in the hematologic and medical status of alcoholics.

Sixty-five skid-road and 47 middle- to upper-class alcoholics underwent hematologic and medical evaluation. Despite major differences in life style and nutrition between these two groups, there was no significant difference in extent of liver disease or anemia. Moreover, the extent of liver disease, anemia, leukopenia, and thrombocytopenia in this community study of functioning alcoholics was significantly less than in a prior hospital study of acutely ill alcoholics. Iron deficiency was the commonest cause of anemia, probably because of frequent donations of plasma and blood by the skid-road alcoholics. Though megaloblastic anemia was infrequent, subnormal serum folate levels were commonly found in the skid-road group. In the middle- to upper-class group serum folate levels were normal in the absence of high blood ethanol levels. Ethanol causes depression of serum L. casel folate level, thus complicating assessment of folate balance in alcoholics.

Analysis of anemia in medical inpatients.

Five hundred consecutive patients admitted to the medical service of a large general hospital were evaluated for anemia. Decreased hemoglobin levels were detected in 23 per cent of the patients. Hypoproliferative anemia was documented in 52 per cent of the anemic patients, and in 90 per cent of the patients a probable cause was found. Iron deficiency accounted for 23 per cent, folate deficiency for 3.5 per cent, vitamin B12 deficiency for 1.5 per cent, and hemorrhagic-hemolytic (including hemoglobinopathies) for 5 per cent of the anemias. Early death or discharge of some patients resulted in 15 per cent undiagnosed anemias. Early etiologic diagnosis of anemia was often helpful in guiding management of individual patients. Understanding the hematologic characteristics of the population admitted to the hospital helped the house staff to anticipate the probable causes of anemias and allowed the faculty to judge which anemias to emphasize in their teaching.

Oral contraceptives, serum folate, and hematologic status.

The effects of oral contraceptives on serum folate and hematologic levels in 526 women were studied by a new radioassay method and by Lactobacillus casei assay. Serum folate levels were not significantly lower compared with a control group (p more than .1 by L casei assay; p more than .2 by radioassay). Hemoglobin values and iron deficiency anemia were significantly less in the control group (p less than .001). It was concluded that oral contraceptives do not cause folate deficiency anemia.

Diverse clinical expression of multiple myeloma--atypical presentations.

Eleven of 57 patients with multiple myeloma presented in an atypical fashion. Commonly obtained laboratory tests were examined for a pattern of abnormality that would aid in the diagnosis of these unusual cases. Common to both the usual and unusual modes of presentation were hypercalcemia, hyperglobulinemia, azotemia, and anemia. Knowledge of the possibility of atypical presentations will aid in the early diagnosis of multiple myeloma and result in optimal treatment, lessened morbidity, and increased survival time.