Excess Hemolysis in Subjects with Severe Iron Deficiency Anemia Associated and Nonassociated with Hookworm Infection.

(With the technical assistance of Adelina ()/eda, Alvaro Carstens and Iris Dugarte) H EAVY HOOKWORM INFECTION is sooner or later associated with iron deficiency anemia mainly due to continuous intestinal blood loss. A mean daily intestinal blood loss of 0.031 ± 0.017 ml. per worm and 2.14 ± 1.0 ml. of hlocd per 1,000 ova per gram of feces was found by means of the erythrocyte Cral tagging method.1’2’3 Thus, subjects with heavy hookworm infection harboring more than 250 worms, i.e., presenting more than 5.000 ova per gram of feces, lose daily over 10 ml. of blood which in subjects vitli hemoglobin values of about 15 Gm. per 100 ml. of blood means a loss of more than 5 mg. of elemental iron. Although a proportion of about 30-40 pe cent of the hemoglobin iron is reabsorbed and utilized again,4’5 the final loss will still be considerable and cannot be met from food iron alone. As a consequence of this unbalance, iron storage becomes depleted and anemia develops. The latter can be taken as a model for chronic iron deficiency anemia, since no other factors besides blood loss has been shown to be responsible for it in most cases. Theoretically, the red cell survival in infected patients should reflect normal erythrocyte destruction plus intestinal blood loss. A third factor will he shown in the present paper to operate in the reduction of red cell survival in iron (leficiency anemia.