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KMID : 0366219790140010003
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Korean Journal of Hematology
1979 Volume.14 No. 1 p.3 ~ p.40
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A Collective Study on Deficiency Anemia in Korea - An Analysis of 1,318 In-Patients -
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°íÀ±¿õ(ÍÔëÈê©)
ÇÑÁö¼÷(ùÛò¹â×)/¹éÁ¾·Ä(ÛÜñ¤Ö)/ÀÌ»ï¿(ì°ß²æí)/À±´öÁø(ëÅÓìòå)/±è±æ¿µ(ÑÑÑÎçÈ)/±èº´¼ö(ÑÑܹâª)(ì¤ß¾òûù¶ÓÛøú)
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Abstract
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This survey was carried out to obtain collective informations on nutritional anemia
among Korean population, sponsored by the Korean Society of Hematology as an annual
academic project in 1978.
Thirteen hundred and eighteen cases of nutritional anemia collected from 16 training
hospitals during the past ten-year period(from January 1, 1968 to December 31, 1977)
were analiyzed.
The results of the analysis were as follows:
1. The frequency of the anemia according to the deficient factors
The most common one was iron deficiency anemia (96.1%, 1,266 cases) and the others
were megaloblastic anemia(3.4%, 45 cases), protein deficiency (0.4%, 5 cases) and
pyridoxine deficiency anemia (0.2%, 2 cases) in decreasing order.
2. Iron deficiency anemia
1) Diagnostic criteria: The criteria uses for defining anemia were those established by
WHO Study Group on Nutritional Anemias in 1968. A state of iron deficiency was
considered to exist with a serum transferrin saturation below 16%, absent stainable iron
in the bone marrow, serum iron below 30§¶% and total iron binding capacity above 350
§¶%, or the increment of hemoglobin by 2 gm% with single iron therapy.
2) Annual incidence: The number of patients showed annual increase but the annual
ratio of the anemic patients to the total in-patients showed no significant change (mean:
0.07%).
3) Age and sex incidence: Out of 1,189 cases, 189 (15.9%) occurred among children
under 15 years of age, and 1,000 (84.1%) at ages above 15 years. Four hundred and
severity six(40.0%) were male and 713(60.0%) female with sex ratio of male to female 1
: 1.5, but the number of male patients were slightly more than that of the female among
children. The peak incidence in the male patients was found at ages of 10¡20 years,
and in the female at ages of 20¡30 years. The over-all peak incidence was found in
adults at ages of 20¡30 years.
4) Etiologic factors: Iron deficiency came about mainly as a late manifestation of
prolonged negative iron balance (excessive loss 79.9%, decreased intake 9.6%, and
impaired absorption 4.8%), and also because of failure to meet an increased physiologic
need for iron(7.7%). Gastrointestinal bleeding was by far the most common cause of
excessive loss(UGI bleeding 51.5%, rectal bleeding 8.6% and parasites 7.1%) and, is
second to excessive menstrual blood loss(11.7%) as a cause in women. The interesting
findings in causative factor of impaired absorption were that intestinal tuberculosis was
the most frequent one in malalsorption syndrome which was rarely seen. Some causes
of excessive loss were given in table 7.
5) Clinical manifestations: Most patients saught medical attention because of general
(fatigue, dizziness, etc.), gastrointestinal (indigestion, abdominal discomfort, etc.) or
cardiopulmonary (palpitation, breathlessness, etc.) symptoms. The incidence of epithelial
abnormalities was very low (glossitis 2.4%, angular stomatitis 1.0%, dysphagia 1.0%,
koilonychia 0.9% and ozaena 0.2%).
6) Laboratory findings:
a) Hemoglobin level: The mean hemoglobin level was 7.53gm% (male 7.27gm%, female
7.71gm% and the pregnant 8.20gm%). In 25.7% of the cases hemoglobin level was less
than 6gm%, and most of them had hemoglobin level between 6 and 12gm%. Seventeen
cases(1.3%) showed iron-lack without anemia.
b) Leukocyte counts: In 12.9% of the cases the counts was below 4,000/§§ and in
18.3% more than 10,000/§§(mean: 9,000/§§).
c) Reticulocyte counts: The mean reticulocyte count (not corrected) was 2.2% and
48.7% of the cases had counts above 1.5% and 11.3% below 0.5%.
d) Platelet counts: In 13.4% of the cases counts was below 100,000/§§> and in 9.9%
more than 400,000/§§ (mean: 232,000/§§).
e) Serum iron level: In 36.2% of the cases levels were below 30§¶% (mean: 45§¶%,
male 43§¶%, female 46.6§¶% and the pregnant 58.6§¶%).
f) Total iron binding capacity: In 57.3% of the cases levels were above 350§¶% (mean:
378§¶% ; male and female 371§¶% and the pregnant 448§¶%).
g) Transferrin saturation: In 70.6% of the cases saturations were below 16% (mean:
13.5% : male 12.3%, female 14.1%, and the pregnant 11.5%).
h) Peripheral red cell morphology: In 65.6% of the cases, there were microcytic and
hypochromic pictures and in 3.4% macrocytic on peripheral blood smear.
i) Hookworm infestation rate (8.4%) was slightly higher than that of general
population(10.8% in 1971, 2.1% in 1976). Infectivity with trichocephalus trichiuris(56.7%)
which is a possible etiologic factor of blood loss was similar to that of general
population(65.8% in 1971, 40.3% in 1976).
j) Bone marrow iron: Iron staining of the bone marrow was performed in 370
cases(51.2%). Stainable iron was absent in 215 cases (58.1%) and trace in 77
cases(20.8%).
7) Management and response: Eight hundred and forty-two cases (82.9%) were
treated with iron preparations (oral 73.1%, parenteral 7.1%), 695 cases (68.4%) with
transfusion(whole blood in 598 cases, packed cells in 97 cases), and 39 cases (3.8%)
with operations. One hundred and twenty-two cases (15.5%) showed complete recovery
with therapeutic maneuvers. Eighty-four cases (10.9%) required less than two months of
period for normalization of hemglobin without transfusion (mean: 29.5 days). Relapse or
no response(128 cases, 16.1%) was probably stemmed from uncooperability(55.2%),
uncorrectability(32.8%), improper dosage of drug (10.3%) and continuous bleeding (6.9%)
in order.
3. Megaloblastic anemia
Total 45 cases of megalobastic anemia were collected during ten years (folate
deficiency 18 cases, vitamin B12 deficiency 16 cases, combined 2 cases,
and unclassified 9 cases). The sex incidence in male was higher than in female on both
deficiency and for the age distribution; in the folic acid deficiency group, it was most
frequently seen at 20¡50 years of age (47.1%) and in vitamin B12
deficiency 50¡60 years of age (37.5%).
As the causative factory of folic acid deficiency, liver cirrhosis was 4 cases (36.4%);
and gastric disorders such as gastric cancer, ulcer, achlorhydria and so on were 7 cases
(63.6%) in vitamin B12 deficiency.
The reasons for low incidence and inadequate statistical data on nutritional anemia in
this survey were considered to be primarily from 1) insufficient record of chart, 2)
statistical observation only for in-patient cases, 3) patients attitude of negligibility of
so-called anemia, and 4) inadequate and poor utilization of diagnostic laboratory
procedures.
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