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

An excess hemolysis was found in subjects with iron deficiency anemia associated with hookworm infection. Red cell survival, measured with Cr⁵¹ andDFP³² in the subjects before deworming, showed a marked disproportionbetween the decrease of the survival and the amount of daily intestinal bloodloss in most cases. Excess of hemolysis was still present after more than 90 percent of the parasites were removed. Red cell survival became normal aftercorrection of anemia through iron treatment. Excess of hemolysis was alsopresent in noninfected subjects with iron deficiency anemia due to othercauses.

The reduction in the survival of the erythrocytes from infected subjectstransfused into normal recipients shows that the hemolytic process is due toan intrinsic defect of the red cells. The low values of hemoglobinemia andthe presence of haptoglobins in the plasma indicate that hemoglobin has notbeen liberated in excess intravascularly. Finally, the fact that the red cellsfrom an infected patient taken after deworming survived normally in splenectomized recipients indicates that the spleen is probably the principal siteof the red cell destruction. The clinical and autopsy findings suggest thatsplenic function is not pathologically increased, but rather that this organ isacting physiologically at a more rapid rate, "culling" the abnormal circulatingred cells and thus leading to a decrease in red cell survival.

The studies presented here also indicate that the hookworm infection perse does not induce hemolysis.

Submitted on January 13, 1964 Accepted on April 24, 1964