82
aplastic anxmia and that using the agar technique it is not possible to corroborate the data of Yunis 4 using a different technique that these cells are sensitive to chloramphenicol. Further studies of myeloid progenitor cell kinetics related to cell morphology in aplastic anxmia are badly needed. A. HOWELL* T. M. ANDREWS R. W. E. WATTS.
Clinical Research Centre, Harrow, Middlesex HA1 3UJ.
ABNORMAL HÆMOGLOBINS IN SOUTH-EAST STAFFORDSHIRE
FINGER CLUBBING SIR,-Your editorial (June 7, p. 1285) omits mention of a hypothesis to explain certain types of clubbing which has experimental evidence to support it.l-3 It was proposed that the engorgement of the finger tips in clubbing is due to dilatation of the arteriovenous anastomoses under the influence of vasodilator material (probably reduced ferritin) normally present in mixed venous blood, which escapes inactivation by the lung because of right to left shunting. As far as I know this theory has not been disproved or
superseded. 6 Friars Walk, Exeter EX2 4AY.
SiR,—There seems to be a high frequency of haemoglobinopathies in both the local and immigrant populations of this part of Great Britain. During the past 3 years we have screened 726 patients (584 immigrants and 142 local population) for abnormal haemoglobins by CAM electroABNORMAL HEMOGLOBINS IN STAFFORDSHIRE POPULATIONS 1
1
,
G. H. HALL.
PREGNANCY AFTER RENAL TRANSPLANTATION
SiR,—The paper by Dr Evans and his colleagues (June 21, p. 1359), which I have just seen for the first time and concerns one of my patients successfully treated by hxmodialysis and cadaver kidney transplantation, contains an error. The dose of azathioprine was in fact 100 and not
50 mg.
daily.
While I would agree with the cautious attitude expressed by the authors towards pregnancy in women after kidney transplantation, it has not been my practice to recommend restrictions in this regard and I was glad to see that comment was made in the paper that the theoretical teratogenic risk has not been confirmed in practice. Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London W12.
*
Including
1
VITAMINS AND ORAL
homozygote.
phoresis, using Tris buffer pH points are worth noting:
8-9
(see table).
A few
1. Blood-counts and red-cell morphology in these cases of not reveal any consistent pattern but varied from normal to gross abnormality. 2. A knowledge of the geographical origin of a person under investigation for abnormal haemoglobin was very helpful, especially in differentiating Hb S and Hb D traits. An abnormal fraction moving between Hb A and Ain an immigrant from Pakistan invariably indicated Hb D trait, whereas in individuals from the West Indies it was Hb S trait in all cases. So one should be sceptical about an apparent diagnosis of sickle-cell trait in Pakistani immigrants and Hb D trait in West Indians. 3. &bgr;-thalassaemia does exist in the so-called " pure " English population, and is quite common in some villages in Staffordshire (Abbots Bromley and neighbouring areas) which may have historical importance, going as far back as the Roman invasion of Britain. 4. Some of the immigrants have married local girls and have transmitted the abnormal hxmoglobin gene to some of their children. There is a possibility that these children will, in due course, marry English men and women and will again transmit the same abnormal gene to some of their children. If this process goes on, in a few generations these hxmoglobin abnormalities will no longer be uncommon in Britons.
haemoglobinopathies did
We therefore feel that couples of different racial origins who intend to marry should be screened for the presence of abnormal hxmoglobins. It would be interesting to know the views of others on this topic. Department of Hæmatology, Burton Hospitals, Burton-on-Trent, Staffordshire. 3. 4.
M. E. BUCKLEY P. E. BRASSINGTON M. J. LONG.
Howell, A., Andrews, T. M., Watts, R. W. E. Lancet, 1975, i, 65. Yunis, A. A., Harrington, W. J.J. Lab. clin. Med. 1960, 56, 831. *Present address: Department of Medicine, Birmingham University.
RALPH SHACKMAN.
CONTRACEPTIVES
SIR,-As Professor Wynn (March 8, p. 561) points out, reduced levels of ascorbic acid are found in women using oral contraceptives, but the 500 mg. daily that he suggests would be required to normalise blood-levels may be too little for women whose vitamin-C intake has been low for a long time, unless this dose is sustained for several months. Using a lingual test4 for the vitamin, we have found that young women excreting a mean amount of 41-2:26-5 (n=77) mg. ascorbic acid in 24 hours have a plasma-level of 1-0020-255 mg. per 100 ml. (n=31), whereas women in the same age-range using oral contraceptives had plasma-levels of 0-688±0-405 mg. per 100 ml. (n=9), which differs from the control group significantly (P < 0-02). To determine the fate of high-dose supplements of vitamin C, 6 women (using oral oestrogens) were given 3-3 g. ascorbic acid at bedtime; after a night’s sleep their plasma-levels had risen from 0-939 ±0-073 to 1-2060-178 mg. per 100 ml., but within 24 hours it had again fallen to 0-945± 0-184 mg. per 100 ml. Although their plasma-levels rose their first urinary excretion after significantly (P
aplastic anxmia and that using the agar technique it is not possible to corroborate the data of Yunis 4 using a different technique that these cells are sensitive to chloramphenicol. Further studies of myeloid progenitor cell kinetics related to cell morphology in aplastic anxmia are badly needed. A. HOWELL* T. M. ANDREWS R. W. E. WATTS.
Clinical Research Centre, Harrow, Middlesex HA1 3UJ.
ABNORMAL HÆMOGLOBINS IN SOUTH-EAST STAFFORDSHIRE
FINGER CLUBBING SIR,-Your editorial (June 7, p. 1285) omits mention of a hypothesis to explain certain types of clubbing which has experimental evidence to support it.l-3 It was proposed that the engorgement of the finger tips in clubbing is due to dilatation of the arteriovenous anastomoses under the influence of vasodilator material (probably reduced ferritin) normally present in mixed venous blood, which escapes inactivation by the lung because of right to left shunting. As far as I know this theory has not been disproved or
superseded. 6 Friars Walk, Exeter EX2 4AY.
SiR,—There seems to be a high frequency of haemoglobinopathies in both the local and immigrant populations of this part of Great Britain. During the past 3 years we have screened 726 patients (584 immigrants and 142 local population) for abnormal haemoglobins by CAM electroABNORMAL HEMOGLOBINS IN STAFFORDSHIRE POPULATIONS 1
1
,
G. H. HALL.
PREGNANCY AFTER RENAL TRANSPLANTATION
SiR,—The paper by Dr Evans and his colleagues (June 21, p. 1359), which I have just seen for the first time and concerns one of my patients successfully treated by hxmodialysis and cadaver kidney transplantation, contains an error. The dose of azathioprine was in fact 100 and not
50 mg.
daily.
While I would agree with the cautious attitude expressed by the authors towards pregnancy in women after kidney transplantation, it has not been my practice to recommend restrictions in this regard and I was glad to see that comment was made in the paper that the theoretical teratogenic risk has not been confirmed in practice. Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London W12.
*
Including
1
VITAMINS AND ORAL
homozygote.
phoresis, using Tris buffer pH points are worth noting:
8-9
(see table).
A few
1. Blood-counts and red-cell morphology in these cases of not reveal any consistent pattern but varied from normal to gross abnormality. 2. A knowledge of the geographical origin of a person under investigation for abnormal haemoglobin was very helpful, especially in differentiating Hb S and Hb D traits. An abnormal fraction moving between Hb A and Ain an immigrant from Pakistan invariably indicated Hb D trait, whereas in individuals from the West Indies it was Hb S trait in all cases. So one should be sceptical about an apparent diagnosis of sickle-cell trait in Pakistani immigrants and Hb D trait in West Indians. 3. &bgr;-thalassaemia does exist in the so-called " pure " English population, and is quite common in some villages in Staffordshire (Abbots Bromley and neighbouring areas) which may have historical importance, going as far back as the Roman invasion of Britain. 4. Some of the immigrants have married local girls and have transmitted the abnormal hxmoglobin gene to some of their children. There is a possibility that these children will, in due course, marry English men and women and will again transmit the same abnormal gene to some of their children. If this process goes on, in a few generations these hxmoglobin abnormalities will no longer be uncommon in Britons.
haemoglobinopathies did
We therefore feel that couples of different racial origins who intend to marry should be screened for the presence of abnormal hxmoglobins. It would be interesting to know the views of others on this topic. Department of Hæmatology, Burton Hospitals, Burton-on-Trent, Staffordshire. 3. 4.
M. E. BUCKLEY P. E. BRASSINGTON M. J. LONG.
Howell, A., Andrews, T. M., Watts, R. W. E. Lancet, 1975, i, 65. Yunis, A. A., Harrington, W. J.J. Lab. clin. Med. 1960, 56, 831. *Present address: Department of Medicine, Birmingham University.
RALPH SHACKMAN.
CONTRACEPTIVES
SIR,-As Professor Wynn (March 8, p. 561) points out, reduced levels of ascorbic acid are found in women using oral contraceptives, but the 500 mg. daily that he suggests would be required to normalise blood-levels may be too little for women whose vitamin-C intake has been low for a long time, unless this dose is sustained for several months. Using a lingual test4 for the vitamin, we have found that young women excreting a mean amount of 41-2:26-5 (n=77) mg. ascorbic acid in 24 hours have a plasma-level of 1-0020-255 mg. per 100 ml. (n=31), whereas women in the same age-range using oral contraceptives had plasma-levels of 0-688±0-405 mg. per 100 ml. (n=9), which differs from the control group significantly (P < 0-02). To determine the fate of high-dose supplements of vitamin C, 6 women (using oral oestrogens) were given 3-3 g. ascorbic acid at bedtime; after a night’s sleep their plasma-levels had risen from 0-939 ±0-073 to 1-2060-178 mg. per 100 ml., but within 24 hours it had again fallen to 0-945± 0-184 mg. per 100 ml. Although their plasma-levels rose their first urinary excretion after significantly (P
