Anemia of Kwashiorkor in Cairo: Deficiencies of Protein, Iron, and Folic Acid

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Abstract
Anemia in kwashiorkor was characterized in 24 Egyptian patients less than 2 years of age by examination of peripheral blood, bone marrow smears, serum iron and iron-binding capacity, folate, vitamin B12, and vitamin E. Seventeen of the patients were followed to hematologic remission by sequential 2-week therapeutic trials of diet alone (reconstituted powdered milk), parenteral iron, and subcutaneous folic acid. Nineteen well babies from the same hospital constituted a control group. On admission the mean hemoglobin level of the anemic group was 8.5 g/l00 ml ± 2.14 sd and two-thirds of the peripheral blood films were dimorphic. The bone marrow was megaloblastic in 70.3%, with decreased to absent hemosiderin in 87%. Low serum folate levels correlated with the degree of anemia and the presence of megaloblastosis. In all the patients the serum vitamin B12 levels were high, and the serum vitamin E levels were uniformly low. In the treated group, reticulocyte responses were observed to diet alone in 53%, to iron dextran in 64.5%, and to subcutaneous folic acid in 29%. Megaloblastic bone marrows were uniformly corrected during the folic acid therapy period. At the completion of the study, serum vitamin E levels remained subnormal. The anemia of kwashiorkor in Cairo is usually megaloblastic, with a dimorphic blood film, and is responsive to a combination of dietary protein with supplemental iron and folic acid. With this therapeutic regimen, thee deficiency of vitamin E that accompanies kwashiorkor is not hematologically limiting.