Haematology reports of routine blood films in patients with burns.

A retrospective pilot study of 99 peripheral blood films from 27 patients with burns is reported. Abnormalities of the granular leucocyte series were more common in the more extensive burns and usually preceded bacteriological evidence of wound pathogens or a clinical decision to take a blood culture. The evidence suggests that a prospective study is needed to determine the possible clinical value of reporting such granulocyte abnormalities. Abnormalities of the myelo-monocytic and lymphocyte cell lines were sufficiently frequent to permit fundamental research of possible relevance not only to patients with burns but in other host responses such as in sepsis, malaria or AIDS.

Severe morbidity among children in a trial malaria chemoprophylaxis with pyrimethamine or chloroquine in Ibarapa, Nigeria.

In a controlled trial of weekly malaria chemoprophylaxis with chloroquine and pyrimethamine there were no significant differences in type and frequency of severe morbidity during chemoprophylaxis. Administration of chemoprophylaxis during the current and immediately preceding month was associated with significantly fewer episodes of severe morbidity in the chloroquine and pyrimethamine groups when each was compared with the control multivite group. After chemoprophylaxis had been stopped, significantly more episodes of severe morbidity occurred in the chloroquine group than the control group, but a similar trend in the pyrimethamine group was not statistically significant. In the control group most of the episodes of severe morbidity, including those episodes which were associated with heavy parasitaemia, occurred below the age of 4 years. In contrast, the children who received chemoprophylaxis continued to experience such illness at older ages. The difference between the chloroquine group and the control group in respect of age at time of severe morbidity was statistically significant.

The contribution of Ruscoe Clarke and his team to knowledge relevant to blood loss after injury.

The major contributions of Ruscoe Clarke, made between 1947 and 1959 at the Birmingham Accident Hospital, are recalled. He and his team measured the red cell volumes. By these and other means we estimated the average blood loss from a series of civilian injuries. It was found that the lowest haemoglobin level 4-14 days after injury was a useful clue in retrospect of the degree to which blood lost had been replaced by blood transfusion. We showed that early transfusion of the correct volume of whole blood appeared to lead to the best chance of quick and full recovery from serious injury. We stressed the need to assess the blood transfusion requirement more precisely.

Iron deficiency in pregnant women in Ibarapa District of Western Nigeria.

Ninety-nine pregnant women with anaemia (haematocrit less than 0.30) were detected by antenatal screening in Ibarapa District. Studies on 23 anaemic women and 17 non-anaemic women from the same clinic on the same day showed that eight out of 23 anaemic women had a transferrin saturation of less than 15%. The mean level (19.5%) for the anaemic patients was significantly less than that found in the nonanaemic controls; mean 33.0% (P less than 0.01). Bone marrow studies on 32 anaemic women revealed megaloblastic change and absent iron in 27 of the 32 patients. In a trial of parenteral iron treatment in 66 patients the mean haematocrit of Imferon treated patients rose from 0.27 to 0.32 in 6 weeks but remained at 0.28 or less in the controls. There was a significant difference between the iron-treated group and the comparable group receiving no imferon (P less than 0.001 at 6 weeks). The method of using parenteral iron treatment to make a diagnosis of iron deficiency anaemia is discussed together with the possible advantages and disadvantages of giving iron.

Sickle cell anaemia: diagnosis and care in a Nigerian health centre.

A study of 156 cases of SS and SC disease diagnosed at Igbo-Ora between 1962 and 1975 is described. In 1971 haemoglobin electrophoresis was introduced for all previously untested patients with a PCV of less than 30 and/or a clinical suspicion of SS or SC. Following this, the total known cases of SS and SC disease rose from nine to 156 in four years. The new cases diagnosed within one year of birth rose from zero before 1971 to 10 in 1974. This is 25% of all expected cases. The percentage of cases diagnosed within one calendar year of detecting anaemia (PCV less than 30) rose from 0 to 94%. It is concluded that haemoglobin electrophoresis is of great value in improving early diagnosis in peripheral clinics. Ways of further improving the early diagnosis and management of SS and SC disease in peripheral clinics is discussed.