Jerry D. Reeves

The hematopoietic effects of prednisone therapy in four infants with osteopetrosis.

Sequential hematologic studies were performed in four infants with malignant osteopetrosis who received prednisone. Prednisone therapy resulted in decreased liver and spleen size, decreased numbers of circulating immature blood cells, and increased hemoglobin concentration and platelet counts in all infants. The quantity and quality of hematopoietic tissue in bone marrow biopsies improved during prednisone therapy but showed no significant improvement without therapy. Sequential indium 111 chloride scans in one infant showed increased uptake in long bones and pelvis and decreased uptake in liver and spleen during therapy. We conclude that prednisone therapy of infantile osteopetrosis results in increased bone marrow hematopoiesis and decreased extramedullary hematopoiesis.

Anemia of acute inflammation in children

We measured sequential changes in hemoglobin concentration and erythrocyte sedimentation rate in 27 previously healthy children hospitalized for a variety of moderately severe acute inflammatory processes. Among 18 retrospectively studied children, 61% had mild anemia for age on admission, and Hgb values dropped greater than 2 SD in 83% during active inflammation. During recovery, Hgb concentrations spontaneously rose greater than 1.3 gm/dl in 79% of the children. Mean Hgb drop was 1.8 gm/dl in 5.6 days, representing an average noniatrogenic blood loss of 107 ml, among nine prospectively studied children. Only one of these had laboratory evidence of hemolysis, and none had clinical evidence of bleeding or overhydration. Results of both studies combined showed that a mean 13% Hgb drop during active inflammation was followed by a mean 24% Hgb rise during resolution of acute inflammation. We conclude that most children with moderately severe acute inflammation experience a significant drop in Hgb within 1 week of illness onset, regardless of the specific cause of inflammation. In general, this mild to moderate anemia resolves without hematinic therapy.

Iron deficiency in one-year-old infants: Comparison of results of a therapeutic trial in infants with anemia or low-normal hemoglobin values

The purpose of this study was to determine the Hgb response to a therapeutic trial of iron in infants with anemia compared to those with low-normal hemoglobin values. Hgb was determined in 1.128 one-year-old infants. The 278 infants (25%) who had an Hgb less than 11.5 gm/dl were given a three-month oral course of ferrous sulfate (3 mg iron/kg/day); the regimen was satisfactorily completed by 188 infants. Of the 75 infants whose initial capillary Hgb was in the anemic range (Hgb less than 11.0 gm/dl), 45% had an increase in venous Hgb greater than or equal to 1.0 gm/dl. Of the 113 infants with initial capillary values in the low-normal range (11.0 to 11.4 gm/dl), 28% had greater than or equal to 1.0 gm/dl Hgb response. Despite the lower rate of response in the low-normal group, almost half of the infants with a greater than or equal to 1 gm/dl response would have been missed by using the generally accepted cutoff value of 11 gm/dl for a therapeutic trial. Because of the low cost and simplicity of a therapeutic trial, we favor including the low-normal Hgb group for a therapeutic trial of iron in order to avoid missing iron-responsive individuals among groups of infants with a similarly high prevalence of iron deficiency anemia.

ANEMIA IN INFANTS WITH MILD INFECTIONS

A group of 467 healthy infants had Hgb, MCV, erythrocyte protoporphyrin (EP), serum ferritin (SF), serum iron (Fe) and TIBC measured as part of a nutritional evaluation in conjunction with the well child examination at 12 months of age. In addition to the nutritional history, the frequency of clinic visits within 3 months of examination related to infection (URI, otitis, gastroenteritis) was determined. Frequent recent infection visits were associated with a pattern of reduced Hgb, MCV, and Fe with elevated EP and SF that is also characteristic of the anemia of chronic inflammation. (In iron deficiency, SF is typically decreased.) Of the infants with ≥ 3 recent infections, 22% had Hgb<11.5 g/dl, in contrast to 9% of those with no infection (p=0.005,X2). A subgroup of 323 infants was treated with either placebo or iron (30 mg iron/day as ferrous sulfate) for 3 mo. The percentage of subjects with a≥1g/dl rise in Hgb was 35% in infants with ≥3 infection visits compared to 13% in those with no infection visits (p<0.001). Each of the response rates was slightly but not significantly higher in the iron treated compared to the placebo group. Mild, acute, antecedent infections contribute substantially to the frequency of low Hgb values in infants who are screened for iron deficiency.