6~
Medical Research Society
Alh4 To analyse changes in lvmphoid and mveloid cell sub popllations in the
M2 I
t a ~ c amucosa
l
of women presentingwth and wthout c e ~ c i t iand
~ . compare such
changesuith matched penpheral blood specimens from the same ind~nduals
METHODS C l i ~ c a ldetads of nineteen women attending a GUM clinic were
cbcained. includtng sexual histow. number of sexual panners. method and Iype of
contracepion and prewous sexually acquired infections Endoce~falswabs were
taken at mid menstrual cycle for screelung of Chlamvdra trachomala, Nelssena
smear for Gram st;unmg
gonorrhoeae. H e m simdex cultures includrng
and HIV antibodv testine (ELISA) CeMcal e~lthelialcells ob(ained using a fine
and matched penpheil Mood
cemcal q t h s h rotaii wthin the c e ~ c a&Il
mononuclear cells isolated from hemnlused venous Mood were washed in
phosphate-hffer d i n e and sutface' smned wth m~noclona~a n u w e s to
cleternune cellular phenohp. along wth appopnate isotype controls Specificsub
ropulations of labelled cells were analysed using FACScan flow qlometer
W S U L l S Mean number of mononuclear cells isolated from c e ~ lc a lspecimens
Ten women were considered to have cemcitis on clintcal and nucroscoplc cntena
ind lune were wthout All were negative for anti-HIV antibodies The overall veld
,of mononuclear cells was consistentlv lower for c e ~ c a samples
l
than penpheral
blood Women wth c e ~ c i t had
i ~ relativelv lugher velds of macrophages and
HLA-DR' than those wthout Cemcal B-lymphocS2es were stnlanglv reduced in
ill subjects incltdng those wth cervicitis
ICONCLUSION CeMcal ombrush tecbque ulth flow cvIometry offers a
pranical non-invasive method of investigating cellular sub popllations in women
with lower genital tract infections Increased numbers of macrophages and the
~xesenceof MHC class II on a large number of non-pfesional cells may i~&cate
i.xpanded local stimulation by T-helper cells possibly playmg a role in controlling
declion of the ~ M XThe nmral absence of m c a l B-lymphocvtes indrcates
ilulumal blood contamnation and suggests absence of local immunoglobulin
production
M2O BENIGNHYPERBILIRUBINAEMIA
I N TWALUAN
SCHOOLCHILDREN
RELATIONSHIP OF MEAN
CELLVOLUME AND BLOODLEADIN
LONDON SCHOOLCHILDREN AT L O W LEADLEVELS
*S R CHALKLEY', *J O'DONOHOE', *J RICHMOND', T HARD MAN^ and
(*Introduced)
*D BARLTROP~
Departments of 'Chld Health & 'Cardio-pulmonary Medicme Impend
College School of Medicine, Chelsea & Westminster Hospital, London,
UK and 'Eme Hospital, Enniskillen, Co Fermanagh, UK
The toxic effect of exposure to high lead levels on haematological
parameters has been well documented. However, the toxic effect of lead at
low concentrations is still uncertain. Threshold values have been proposed
below which lead is no longer believed to have deleterious effects. Doubt
has been raised, however, as to whether these levels really do represent a
concentration at which lead no longer has a clinical impact, especially in
children.
An investigationof the relationship between blood lead and mean cell
volume, (MCV), in schoolchildrenwas conducted to determine whether
there was a threshold level for the effect of lead on red blood cells. Venous
blood was taken from 640 schoolchildren (383 boys and 257 girls) living in
a central London district. The mean age of the group was 9 . 2 [range
~
4.913.4.1. Blood lead was measured by atomic absorption spectrophotometry,
haemoglobin, (Hb), mean cell volume, (MCV), mean cell haemoglobin,
(MCH), mean cell haemoglobin content, (MCHC), by a T540
Haematology analyser, serum iron, (Fe) and unsaturated iron binding
capacity, (UIBC), were measured using a Hitachi 7 I7 analyser. Ferritin
was measured using a commercial IRMA kit and erythrocyte
protoporphyrin, (EPP), with a haematofluorimeter.
Correlation between blood lead and MCV, controlling for levels of EPP,
Hb and Fe, was -0.1809. p<O.OOl. Multiple regression analysis showed a
highly significant relationship between Hb, EPP, b l d lead, and serum
iron with MCV (P<0.05 in all cases). MCH, UIBC, MCHC and fenitin did
not show significant relationships with MCV.
These results highlight a significant relationship between blood lead and
MCV; appearing to be continuous and having no threshold. This raises the
possibility that low lead levels, previously considered acceptable, may have
long term effects on the health of schoolchildren.
*S R CHALKLEY~,
T HARDMAN'and *D BARLTROP' ('Introduced)
D-rtments of 'Child Hcatlh & 'Cardiovascular Medicine. Imperial Collcge School of
Medicme. London. UK
Field testing of laboratory equipment and methods for the measurement of
bilirubin in a remote environment was combined with a dietary iron supplement
study during a two year residence on Vaitupu, Tuvalu, (formerly part of the
Gilbert and Ellice Islands).
Peripheral blood samples were obtained from 234 children. Samples from 154
children, 57 male and 97 female, were analysed for total bilirubin. The
children, aged between 9 and 18yr, were of either Polynesian [n= 145, from
the eight Tuvalu islands] or Micronesian [ n = 9 , from Kiribati]. Blood was
collected into heparinised capillary tubes, sealed and centrifuged. Total
bilirubin was measured using a standard Bilirubin Test-Combination Kit with
modified volumes, 50vl plasma was dispensed with a positive displacement
micmlitre diluting device, "Swizzlestick".Tests were read against a water
blank in a MonA colorimeter.
All participants were healthy at the time of blood sampling. There were no
significant differences between the 234 children in the main group and the
subgroup of 154 with regard to propoltion of children from each island or age
range. There was, however, a greater percentage of females in the subgroup,
I63.0961 than in the main group 137.5961. Mean total bilirubin values were
13.02irmolll(1.91-44.27vmol/l)in Polynesian and 9.81umolll (6.2112.75pmolll) in Micronesian children. There was a significant difference
between values of bilirubin between the 9 different islands, ANOVA F=2.39.
df=8, p<O.O2, but not between males and females, ANOVA F = 1.88, df= I ,
p=O. 17. Of the Polynesian children, 21 % had total bilirubin values
> I7pmol/l, manifesting hyperbilirubinaemia, no values were above l7pmoIll
in the Micronesian group.
The equipment used to measure total bilirubin was robust and reliable. The
range of bilirubin values suggest the presence of genetically determined
benign hyperbilirubinemia.Gilbert's syndrome could be indicated as no
values were above 50~1mollland the condition was benign. However, in
Gilbert's syndrome the prevalence in the general population is 3-5%with
male predominance, but in this study the incidence of values over I7pmolll
was 21 % with no gender difference. Niutao had the highest range of bilirubin
values, with lower ranges on islands more distant from Niutao. These
findings suggested possible genetic spread of this disorder. No firm
conclusion can be reached as to the cause of the hyperbilirubinemia as
unconjugated bilirubins were not measured.
M22
BLOOD LEAD LEVELS AND INDICES OF ANAEMIA IN MNDON
SCHOOLCHILDREN
*S R CHALKLEY',
*J ODONOHOE~,
*J RICHMOND~,
T HARDMAN'
and
*DBARLTROP'(*Introduced)
Departments of 'Child Health & 'Cardiovascular Medicine, Imperial
College School of Medicine, London, UK and 2Erne Hospital, Enniskillen,
Co. Fermanagh, UK
Although iron deficiency anaemia,(lDA), is the most prevalent nutritional
disorder in the world today, there is no agreement on the haematological
parameters that reliably define iron status. The relationship between low
Mood lead levels and IDA was studied in schoolchildren living in a central
London district.
Venous hlood samples were obtained from 640 children, 383 boys and 257
girls, mean age 9.2 years, range 4.9-13.9. Blood lead, (Pb), was measured
hy atomic absorption spectrophotometry, mean cell volume, (MCV), mean
cell haemoglobin, (MCH), by a T540 Haematology analyser, ferritin using
a commercial IRMA kit and erythrocyte protoporphyrin, (EPP), with a
haematotluorimeter. Groups 1-5 were defined by MCV, MCH and ferritin:
I Not anaemic:(MCV > 81;MCH > 3l;ferritin> 12)
2 NormocyticlhypochromiclFe low:(MCV > 81:MCH < 3l;ferritin < 12)
3 NormocyticlhypochromiclFenormal:(MCV> 8I;MCH < 3l;ferritin > 12)
4 MicrocyticlhypochromiclFe normal:(MCV< 8I;MCH <3l;ferritin> 12)
N=
EPP@g/dl
mean
(range)
18.4
(6-35)
20.1
(443)
20.4
(7-50)
21.4
(647)
26.8
(14-56)