From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
iron
The
By
Use of Radioactive
Iron
D.M.,
M.R.C.P.
J.
BADENOCH,
T
HERE
IS
tract
with
EVIDENCE
depends
jects.’
‘
respond
occurs
or
poorly
evidence
failure
use
more
of
need
the
lack
and
radioactive
the
with
ats
associated
steatorrhea.3
response
some
to
iron
thats
the
of
patietsts
normal
sub-
w-hich
mouth.
When
There
has
as
fails
this
beets
its steatorrhea
such
meatis
that
anemia
by
iron
factor
M.R.C.P.
gastrointestitsal
and
iron
oral
other
provided
the
iron
iron-deficiency
treatment
to
iron
more
to
of
not
for
Utilization
M.D.,
from
body
al)sorl)
an
and
CALLENDER,
of iron
of
have
reveal
that
absorption
in
The
pre-
is due
faulty
to
utilization.
investigating
the
problem
closely.
The
5%-ork
to
steatorrhea
for
responds
T.
ShEILA
anemia
however,
may
of Absorption
absorption
the
patients,
investigation
sumptive
AND
on
Steatorrhea
in Studies
hypochromic
Some
2
in
that
largely
uncomplicated
to
Metabolism
the
but
failure
be
described
also
gives
to
show-s
that
evidence
respond
to
absorptiols
that
this
of
may
isot
iron
is
always
suboptimal
be the
sole
in
reason
by mouth.
iron
MATERIAL
Radioactive
was
iron
defective
Subjects
with
predominantly
anemia.
by
oral
treatment.
mouth
those
after
All
for
intraveisous
iron.
sixteen
of the
in svhom
patietsts
subjects
without
tw-o
They
anemia
fat
absorption
st.eatorrhea.
patietsts
(A.
received
t.reatmeist
not,
the
low
levels
with
megaloblastic
therefore,
all
serum
iron
atsemia
otse
of
suffered
H.
and
from
W.)
B.
indicated
w-ith
to further
had
blood
anemic
al)had
a megalo-
refract.ory
by
grossly
fat
changes
to treatment.
become
of these
ss-ere
defective
blood
refractory
had
alsd
had
the
had
proved
response,
w-ith
these
four
had
fair
patients
of
nine
deficiency;
initial
years
sixteen
In
irois
the
an
but
some
although
of
group
or,
observation
tests
on
in fifteen
steatorrhea.
iron-deficient.
iron
made
Thirteen
idiopat.hic
blastic
the
were
comparison,
steatorrhea.
had
been
In
for
Stealorrhea
Idiopathic
sorption
studies
and,
been
under
transfusion
at
the
some
or
time
degree
of the
of
iron
deficiency.
In the
for
group
several
iron;
From
with
years
the
three
the
others
Nuffleld
folic
had
acid,
never
Department
of
had
developed
shown
evidetsce
Clinical
(M.
patient
K.),
microcyt.osis
of iron
Medicine,
after
and
treatment
a low- serum
deficiency.
The
Radcliffe
Infirmary,
Oxford,
England.
Submitted
We
ance
and
indebted
Fund
for
1953;
t.o Miss
July
are
8,
grateful
to
Mr.
It.
to Professor
financial
Oliver
accepted
for
to
one
publication
Mallett.
expert
L. J. Witts
support
for
Barbara
advice
for
of
and
on
helpful
August
Miss
the
123
1953.
Hunt
measurement
of
crit.icisns
us.
10,
Barbara
and
to
the
for
technical
radioactivity.
Haematology
assist-
We
Research
are
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124
IRON
Steatorrhea
the
as a symptom
poor
had
absorption
of
a hypochromic
from
ulcer,
and
iron-deficiency
bowel
for
pancreatic
other
disease.
a symptom
second
(D.
and
In the
of
with
K.)
anemia
disease,
STEATORRHEA
some
had
l)een
treated
with
(F.
third
three
disease.
for
multiple
Ha.)
had
patients
One
a gastroenterostomy
associated
the
remaining
other
(E.
bleeding
a mixed
megalo-
resections
no
H.)
and
anemia
of
but
the
a severe
steatorrhea.
Subjects
without
This
Steatorrhea
group
causes
consisted
other
ficient
than
diet)
low
was
associated
the
Crohn’s
IN
of some
fat
anemia
a stomal
blastic
METABOLISM
and
serum
of
three
iron,
twelve
steatorrhea
patients
(e.g.
subjects
probably
without
the
with
hypochromic
menorrhagia,
anemia.
result
anemia
gastrointestinal
One
of frequent
of the
(B.
latter
donations
due
to
bleeding,
de-
M.)
had
a
of blood.
METHODS
Two
tests
were
used
with
iron
labeled
Test
of the Utilization
It was
desirable
refractory
used
to
oral
as carrier
by
for
A.E.R.E.,
mg.
tilled
5 c.
water
of
in
given
to the
the
patient
having
nothing
was
eat
to
It
of
has
pearing
the
in the
The
mixed
intravenously
standard.
a constant
from
The
in
was
Fe59
(1 Mc. per
200
mg.
of
was
was
set
hours
after
aside
with
that
1 to
test
the
iron
were
in
days
standard
to the
were
The
and
morning,
appreciable
given
fasting
until
(40
dis-
remainder
the
reduce
administered.
four
mixture
and
will
was
supplied
ml. with
100
or at 9 o’clock
was
of the
to
a standard
proved
was
sulphate
up
mixture
or
had
nsixture*
40 .eg.)
ferrous
radioactive
while
they
dose
t.hree
patients
sulphate
made
as
sulphate
the
every
the
then
a meal
ferrous
uncomplicated
this
was
of Utilization
on
to
subject
allowed
radioactivity
a constant
was
expressed
the
amount
level
as
was
a per-
true
were
iron
states
of the
amount
patients
with
in
made
on blood
the feces
as well.
in
of
absorbed.2
In
hypochromic
only.
iron
our
anemia
More
ap-
earlier
asso-
recently
we
have
the
solution
of Iron
that
was
described
by
autoclaved,
stand
Huff,
syringe.
The
appearing
in
and
was
again
et
added
15 minutes.
for
a calibrated
reached
measure
also
measurements
radioactive
saline
iron-deficiency
is a fair
that.
radioactivity
level
isotope
after
The
in which
a ferrous
solution
ml.
of blood
cells
and
allowed
utilization
given.
was based
and
two
that
of physiologic
well,
One
compared
assumed
Test
intravenous
conditions
to assume
that
all the
who
received
the iron
samples
dose
an
reason
immediately
overnight.
was
and
this
To
This
flask.
least.
steatorrhea
the unabsorbed
method
chloride.
either
red blood
we
in 2 ml.
at
The
added.
and it is safe
state.
Those
shown
Intravenous
ferric
the
For
iron.
was
fasted
total
been
with
as
as possible
iron.
radioactive
activity
experiments
ciated
measured
with
in 20 ml.
The
cent.age
as far
subject
for
measured
reached.
to imitate
Fe59
oral
Iron
treatment
the
an
Fe59.
of Oral
the
of iron
ferrous
the
investigations;
isotope
a volumetric
was
quantities
was in
tise
Harwell,
Fe),
the
in
with
the
to
al.4
Then
cells
expressed
was
was
as
to
4 pc.
12 ml.
10 ml.
remainder
red
Up
about
of
kept
of
of the
the
for
measured
a percentage
Fe59
patient’s
mixture
plasma,
was
the
preparation
every
few
of
the
injected
of
days
total
until
activity
given.t
*
4.0
Ferrous
sulph.
0.2
the
time
gm.;
glucose,
0.6 gm.;
acid
hypophos.
dil.
0.01
ml.;
aq.
chlorof.
ad.
ml.
t
While
at
these
experiments
were
made
this
method
proved
adequate
for
a
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
J.
In the
earlier
involved
a copper
we
Harwell.
to
brass
of
on
upper
the
In
standard
and
is
Fe59
and
6
The
of
the
per
minute
specimen
was
taken
conc.
of the
iron
and
standard
present
The
Blood.
was
of
mixed
before
blood
less
were
taken
feces
is always
feces
The fecal
passed
the
to
collections
in
the
each
of
on
two
In
order
the
percentage
Kg.
may
be
is used
for
2 K.V.
and
sensitivity
the
rate
background
in
stool
prevent
water
of
20 to
for
each
acidified
precipitation
as
test
the
long
355
oxalate.
plasma
the
iron
A 20
radioactivity
preserve
was
standard
physiologic
nsl.
made
geometry,
saline
radioactivity
in
the
and
were
red
cells
weight.
electric
was
l.lender
noted
Since
be taken
less than
with
to
potassium
to
an
radioactivity.
can
ml.
intravenous
with
body
blended
until
the
of the
volume
l)lended
successive
a
and
protein.
that
per
20
dry
were
were cont.inued
stools
to
aliquot
at
the
to
measurement
of the
the
1.0, a 20 Gm.
ml.
was
is satisfactory
containing
80 ml.
day
weight
For
This
occur.
up
be
in
geometry
maximum
necessary
binding
and
estimating
measurement
close
glass.
a bottle
up
was
metal
could
to
20
supply
Therefore
made
alone.
plasma
made
In
total
the
bottle
were
was
water
into
assumed
The
for
taken
counted.
was
beaker.
the
a weighing
20 ml.
being
The
Feces.
to
the
samples
of
the
placed
the bottle
large
provided
and
was
Although
radioactivity
120.
2. This
to
with
inverted
between
volume
A.E.R.E.,
place.
test
1 and
sedimentation
than
volume
a weighed
found
was
into
before
samples
the
to 20 ml.
was
relatively
contain
about.
in
oral
inserted
Re-
25
by
which
photomultiplier
to
bottle
the
feces
solution
cent.
of
between
bound
blood
immediately,
for
was
conditions
found
adherence
up
pipeted
4 per
was
unit
bottle
a constant
These
and
oxalate
supplied
of contamination.
the
used.
as
crystal
that
measurements
empty
of
risk
comparable
was
the
consequent
is completely
sample
be
a background
a pH
made
was
advantage
of about
with
to
any
the
1186)
weighing
plate
blood
Geiger-Mueller
(type
brass
both
a saturated
end-window
iodide
has
in
from
x 40 mm.
to avoid
bottles
above
an
sodium
A thin
these
standard
H2SO4
a 30
12 volts
unused
The
Standards.
the
may
an efficiency
glass
30 counts
with
of
of radioactivity
counter
into
it
For
bias
125
CALLENDER
electroplating
with
and
crystal
they
samples.
made
crystal.
ideal,
that
by
scintillation
put
the
not
order
a discriminator
for
of
of the
system
counted.
being
a
was
top
surface
this
counts
employed
counted
T.
measurement
followed
photomultiplier
be
jig
the
disc,
The
sample
the
digestion
have
SHEILA
in the Samples
experiments
a Kjeldahl
cently
AND
of Radioactivity
Measurement
onto
BADENOCH
the
and
and
two
specific
to
of the
Gm.
gravity
as comparable
1 percent
tralisferred
20
of blended
a volume
ingested
to
aliquots
of 20 ml.
dose
had
been
days.
RESULTS
Utilization
The
of an Oral
radioactivity
with
and
unabsorbed
patients
its the
Fe59 was
twenty-two
radioactive
with,
In general
Dose
appearing
sulphate
labeled
with steatorrhea
The
Test
and
the
eight
values
iron
of those
for the
measuring
we
have
to
the
tests
the
not
diminution
rate
found
in the
of
it
of
utilization
of
from
of iron
w-ith
the
of
t.he
oral
the
utilized
dose
of ferrous
feces
its nitse
of the
the
Fe59
iron
plasma
obtainable.
for
red
cell
production
than
in the
control
group
A notable
exception
is the
a gastroenterostomy.
She
only
ten of the remaining
steatorrhea
intravenous
studying
an
steatorrhea.
are very
much
less
there
is some overlap.
associated
W-ith
(36 per cent).
In
for
activity
follow-ing
recovered
percentage
patients
satisfactory
specific
was
cells
tw-enty-eight
times
in sixteen
patients
in fifteen
subject.s
w-ithout
steatorrhea.
without,
in the group
with
steat.orrhea
(fig. 1, tables
1 and 2) although
woman
(E. H.)
with
st.eatorrhea
showed
an excellent
utilization
twenty-seven
red
measured
times
was
for
iron
red
the
utilization
cell
formation,
clearance.
This
more
recently
may
be
due
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
126
IRON
%Orai
iz, btood..
381
With.
IN
METABOLISM
STEATORRHEA
s5teatorrkoea,
Without
0
Steatorrkoea
A
F’i;.
to
I .-ttilization
subj
(‘cts
idio1)tt
of
Ii afl(l
vit
he
S
thati
2
per
Iti1(l
one
in
‘[hat
due
show-n
the
II
Five
vitls
lw
the
ient
studies
w-ith
in
y-five
pat
icnt
l:tlu’led
wit Ii Fe59
s I n t hi rteen
test
S wit
Is syns)t
allcn)i:t
t\V()
subjects
ic steatorrhea.
on)at
:111(1
(\I.
its
tise
\\‘hi(ls
Tweist
sulph:tte
1)at
ic
given
with
ient.s
st eat orrhea,
st eat oI’I’hea
110
,
(I))
S.
steat.orrhea
t.hati
of
and
utilization
of
svei’e
fron
recoveries
steatorrhea,
F91.
group
failure
fecal
i(liO1)tlthic
ferrous
S WI t Ii hypochromic
W’(IC
rather
nsg.
t hree
II
I)atl(reat
l)etweeti
al)sorption
patients
pat
of tlsese
l)atietlt.
. ( A)
t (‘St S
sttl )j ect
dliffel’ellce
poor
of 200
eat orrhea
Three
Ilollanensic
(cut.
the
C
tlosc
st
i IS t welve
t hree
this
to
. (B )
tests
t est
oral
I hout.
Wi
st eat orrhc:t
( (‘ ) Seventeen
Five
an
alMtrt
B. B.,
atsd
the
control
the
al)sorbed
table
1)
group
is
is
iroti
made
(figs. 2 and 3). In
the experiments
on tw’o
l)tttiei1tS
(H. F. tlil(l
\I. K.) its whom
it w’as known
lost., recovery
of the ingested
iron from
the
(‘lOs(
to
100 per cetit
This
iiI(Iicate(l
that. little,
that an active
sample
of stool
feces and
blood
togetiser
was
if any,
iron could
Isave been
ahsol’l)e(I
format.ioti,
was
.
of
itoti
the
aiI(I
steatorrisea,
Its
the
(et1t
sorption
In
per
the
(cut
strikingly
patient
the
blood
Its 1)0th
exceptioti
of 511(1)
of
insmediatelv
the
itt
absorption.
s-itli one
lresence
JC1’
tttilizedl
appearitsg
iron
the
not
sevet’e
w’ith
greater
itt
and
for
nonatiemic
patients
takeis
patients
of iron
(F.
Ha.),
indlicatitig
1)100(1
format
recoveries
patient.,
hut
w’ith
i(liOpathic
ots
percentage
indication
of
in
B. W.
the other
perhaps
hand,
some
8.7
al)-
ion.
s-ere again
the
the
with
idiopathic
was low’, even
by A. H. and
for,
the
and
a fair
as
uistreated
al)sorption
as show’n
immediate
one
the
be
steatorrhea
steatorrhea
in
the
(dl
llnaccounte(I
without.
than
B.),
(leficiency
\Vtt.S
w’itlsout nt ilization
except
treated
pancreatic
(lO5(! given
subjects
therefore
(B.
iron
for red
could
ansoutits
steatorrhea
to
close
(fig.
100
w-ere
absorbed
3).
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
J.
1.-The
TABLE
BADENOCH
Utilization
of an
(200
mg.
AND
Oral
SHEILA
Dose
ferrous
Age
Sex
Date
E
X
I
given
Iron
as
in
Patients
with
Steatorrhea
carrier)
% oral dose
of Fe
data
-
127
CALLENDER
of Radioactive
sulphate
Hematotogic
Name
T.
LI
Conditions
.l
5’
in
blood
of test
in
feces
‘J
Idiopathic
35
M. S.
F
19. 2.52
9.0
13.
9.4
3.52
3.56
3.94
steatorrhea
29
8t3l
31
79
30
-
1.0
-
After
food
1.1
-
After
food
+
100
mg.
ascorbic
acid
21.
1.53
14.3
3.65
32
t1534
85
95
<1.0
After food
treatment
iron
previ-
(intravenous
6
months
ously)
44
CF.
(29.
12.
F
2.52
3.52
9.0
9.7
4.6
4.17
32
34
70
28
-
<1.0
82
28
-
<1.0
-
After food
After
food
+
100 mg.
ascorbic
acid
Ito.
1.53
15.9
5.0
49
98
32
74
None
102
After
food
iron
previ-
(intravenous
tteatment
6
months
ously)
1 8.
2.52
7. 3.52
B. W.
36
F
43
57
F
M
K. F.
59
F
B.
26
5.45
4.68
4.52
9.4
4.78
112.
9.52
9.1
4.8
25.
3.52
10.9
23.
M. G.
E. C.
B.
10.3
9.6
12.3
13.4
5.25
5.43
41
44
78
81
30
30
33
38
1.2
7.0
0.7
1.7
8. 7.52
11.5
4.08
36
88
32
44
9.1
17. 7.52
12.1
4.78
37
77
33
38
28.
1.53
10.1
4.39
34
77
30
62
12.9
7.Ot
11.3
4.88
39
80
29
23
3.30
26
22
30
8
6.52
7.52
5.8
24.
4.52
M. K.
30
F
F
12.2
5.62
40
79
71
22. 5.52
12.0
5.47
37
68
32
29. 10.52
13.0
6.26
43
69
30
39
K.
M
-
After food (after
eral months)
<1.0
-
2.5
-
-
5.6
-
After
food
After food
Fasting
2.0
84’,
35
-
1.0
-
82
it034
32
-
3.9
-
6. 7.52
11.3
3.05
37
12l3l
24.10.52
13.7
3.85
42
109
33
69
10.
14.4
4.04
45
111
32
98
3.93
10435
(after
Fasting
2.0
1.0
with
95
food
After
food
After
food
Codns
72
treatment
Fasting
After
-
Steatorrhea
41
food
Fasting
-
<1.0
oral Fe for sev-
oral iron
After
food
95
4.8
-
After
Asciated
food
‘
Multipte
disease
resections
of bowet.
E.
52
H.
F
25.
3.52
7.8
, 3.35
28
84
36.0
28
After food
-
‘Part
400
47
of active
mg.
ferrous
4. 3.53
stool
14.9
lost.
sulphate
as carrier.
4.54
47
t04
32
124
3.3
88
‘
After
food
Crohn’s
disease
(iastroenterostoziiy.
Stoniat
F. Ha.
oral
food
After
<1.0
5 months
Fasting
96
85
and
ascorbic
mg.
food
food
food
93’
-
1,000
90
41
14.5
food
3.Ot
31
+
After
41
38
7.52
food
food
-
4.30
I 5.01
3.44
3.
food
Fasting
-
14.3
13.2
13.0
Symptomatic
D.
-
-
J21. 5.52
5. 7.52
21. 5.52
1.53
After
After
After
acid
After
iron
After
After
After
99
<1.0
21
1.53
50
12
-
9.52
M. H.
26
-
29
18.
M
73
2.7
30
23.
53
35
-
69
M
W. L.
28
1.6
73
11.
17.
F
71
34
-
28
F
50
29
1.6
36
36
39
Han3.
70
-
4.93
8.1
H. F.
A. H.
E.
29
4.07
It. 6.52
F
66
36
33
Pancreatic
torrhea
ulcer
stea-
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
128
IRON
2.-The
TABLE.
METABOLISM
IN
of an Oral Dose of Radioactive
(200 mg. ferrous
sulphate
given
Utilization
Hematologic
Name
Age
Sex
Date
76
M
76
F
7.
as
in Subjects
5.52
without
oral dose
of Fe59
Conditions
41>
LI
9.4
LI
in
in
..
blood
feces
-
14.1
LI
LI
4.26
34
80
28
4.78
30
63
27
4.73
33
70
26
22
13. 1
4.45
28
63
26
14
4.03
27
67
27
21
4.22
3.67
26
62
25
18
25
68
24
Remarks
of test
After
-
food
Achiorhydria.
diet. Occult
,
F. H.
Steatorrhea
carrier)
#{149}
.
Mi.
Iron
%
data
x
E.
STEATORRHEA
9.1
-
I Aft-er food
I Fasting
14.0
-
,
14.5
-
Fasting
6.7
-
After
16.0
-
Fasting
-
After
-
Fasting
-
Poor
blood
negative
Telangiectasia.
Epist.axes.
Achiorhydna
E.
Mo.
41
M. U.
F
32
f
1
29.
A.
G.
Ho.
J29. 8.
51
33
F.
8. 8.52
8.52
6.6
6.0
8.52
8.52
17.10.52
F
4.20
37
88
32
38
13.6
13.3
4.20
32
76
26
23
38.0
9.8
11.7
8.4
59
After
food
‘
food
Achlortiydnia.
diet. Occult
negative
Menorrhagia.
broids.
,
Fasting
Duo-
denal
Very
ulcer
poor
42
F
26.
8.7
8.52
4.07
74
30
29
23
75
25.0
diet. Hy-
poclitorhydria.
Occult
H.
Fi-
Achtorhy-
dna
Ilematemesis.
food
I
G.
Poor
blood
blood
I
ative
I Carcinoma
Fasting
neg-
colon.
Hypo-
Melena.
chtorhydnia
M.
54
Stev.
F
3.
1.52
7.3
3.64
28
26
77
18
7.0
89
Fasting
Ulcerative
Fasting
Achiorhydnia.
colitis.
Achlorhydnia
D.
G.
P.
44
5.
F
19
{1t
M
28.
4.53
6.6
2.76
20
72
24
S
6.05
42
70
29
30
17.0
14.0
3.28
25
76
26
8
11.0
-
88
85
After
food
After
food
#{149}
I
G. C.
39
F
23.
4.53
11.0
5.11
39
70
28
25
19.0
82
Fasting
cult
tive
Oc-
blood
nega-
Achiorhydria.
tnitional
ciency
Nudefi-
Menorrhagia.
Acts-
lorhydnia
V. C.
43F
22.5.53
6.3
4.39
28
64
23
t0
79
18.0
After
food
,
Achlorhydnia.
Men-
orrliagia
A.
E.
B.
M.
65
22.
F
28
,
5.53
5.10
45
88
31
3.88
I 37
95
35
4.00
36
90
33
5.11
50
98
48 I 92
35
#{149}‘
14.1
{:
F
77
-
52
5.0
After
food
21.7
-
After
food
36.0
-
87
Fasting
3.8
-
After
5.1
-
Fasting
.
Gastric
32
5.20
Utilization
of Radioiron
Further
patient
of
in
Influence
by
iron
w-hich
(C. F.)
for carcinoma,
in whom
the
injected
Administered
evidence
utilizatiots
tests
M
iron
its
the
w-ho
and
test
(fig.
of Varying
that
t.he
idiopathic
radioiron
179
defect
is its the absorption
steatorrhea
is afforded
administered
received
punctures
food
Normal
the uptake
made
show-ed
by
rather
the
than
results
intravenously.
radiotherapy
in whom
w-as
35
havvene-
subject
Intravenously
was
had
-
laboratory
technician,
ing frequent
I
J. B.
ulcer
Normal
following
Apart
in
from
amputatiots
of
somew-hat
delayed,
all the
a rapid
arid complete
utilization
was
the
of
a
the
one
breast
patients
of the
4).
Conditions
It was thought
t.hat the
varying
the conditions
on the Absorption
absorption
in w-hich
of
it was
the
oral
given.
of Iron
dose
of iron
In five
might
patients
be
with
increased
and
seven
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
J.
E=3
I3ADENOCII
Not
recoverea
AND
StIEILA
i:=j
%
,5%
<i7
8.w.
RBCs’/06
I/b gin.
MC#IC
Nose
</‘o
C.F
MS.
365
/4 - 3
3#
8.8
439
/0’ 1
JO
488
1/ 3
29
26
73
79
/2
8
74
M.c.v
SerwnZron.
/5#{176}/
6%
7%
.SO
/5.9
32
98
./
#{176}h8Looa
3%
<i%
A.H.
3.30
,S 8
22
+8
129
CALLENDEII
Faece,s
4#{176}!.
1.10
T.
1/5
77
85
62
4#{176}!.
<1%
J.3%
626
/30
30
M.H
385
/3 . 7
33
Hf
4.34
69
31
/09
69
2%
/j(C
HF4t
80
23
87%
/4.9
32
/04
/24
(,)
pa_ft
*
Fit;.
nine
2.-The
1xtt
‘
recovery
ient
11 steat
s wit
st,ot
of
an
oral
s/0
200
nig.
recovereS
.3%
4%
38 Y
7%
ferrous
steat,rr/wea
sulphate
labeled
wit lx l’c5
Faeces
%
25
Yo
8%
40/0
30/0
1/70
/8%
/9
%
/4%
$
“0
G.P
,1.St
GM
0.3
G.C.
DP
A.E
364
407
328
439
560
605
$/0
84
‘73
87
66
63
/10
/23
/4/
23
23
64
/0
29
70
3/
76
8
28
70
25
30
77
/lbgm)
Iron..
in
B1ooa
i,
%
420
NC/IC
5eru2n
Pascxe.si.
t
of
orrhea.
Not
RBC
lost
dose
26
76
26
77
29
74
23
/8
23
VC.
88
(,4
3.-The
FIG.
eight
In
to
two
be
other
of
of
steat
100
utilized
of
dose
oral
tests
were
there
it ss-as
with
ascorbic
of
2(t)
mg.
ferrous
sulphate
lalwlNl
with
1e5
in
-
groups
when
patients
mg.
an
orrhea
oral
In 1)otls
fastitsg.
iron
addition
without
steatorrhea
without
subject
the
recovery
subjects
carried
was
given
out
a
on
steatorrlsea
acid
to
the
hot.is after
for
tendeticv
a meal
a greater
an empty
a second
test
was
test
This
had
dose.
stomach
and
with
percentage
(fig.
made
the
of
5).
svitls
iso appreciable
the
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
130
hWY
METABOLISM
IN
STEATORRHEA
/o Ra4ioa4ve
Iron,
R.B.C
iii.’
K.F
C F
-e
100
N.H
I
90
80
70
60
50
40
30J
20
‘.
10
0
LJ
1
Fl(;.
4.-Intravenous
(Shaded
a rca-normal
7o Oral
2
3
ut ilizat
sul
ion
of
.,
...
4
Oys
5
6
after
iron
by
,.
8
7
five
.
9
10
it
13
12
irjection1
patients
witis
idiopathic
steat
orrhea.
)j ect s.)
dote
tR8C
,ects
36
wit4I.
Srrkoe
Witltou.t
Stoatorrhoea
34
32
30
28
26
0
After
foocL
Aftet-food
+ .s.scorbic
a,c
#{149}
Fa.st
2
22
20
i;miiILi1fl1
Fiu.
ferrous
5.-The
effect
of varying
conditions
sulphate labeled
with
Fe59.
on
the
utilization
of
an
oral
tiose
of
200
nsg.
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
J.
BADENOCH
effect.
One thousand
with little
or no effect
AND
SHEILA
mg. of ascorbic
(fig. 5).
T.
was given
acid
131
CALLENDER
to
a third
patient,
again
DISCUSSIoN
The
cause
of idiopathic
sorption
which
soluble
substances
provide
evidence
be only
a part
steatorrhea
occurs
involves
such
as
that
the
absorption
of iron
the
cells
intestinal
remains
unknow-n
but
the
defect
in
fat
vitamins
but
also
simple
w-ater-
only
glucose
there
and
and
urea.7
is aLso a defect
of a general
of the
not
failure
The
in absorptiots.
depends
on
mucosa.8
the
results
in the
production
protein
the
lumen
itself interfere
with
the absorption
associated
with
a gastroenterostomy,
The
patient
steatorrhea,
showed
an
excellent
good
Ha.),
clinical
with
and
a subsequent
Another
patient
(F.
anemic
have
and
more,
iti
relation
bowel
bulky
may
the
absorbed
patients
with
to the
severity
symptoms
diarrhea.
had
in
been
(E.
of her
bow-el
H.)
to
those
oral
test
as 12 per
symptoms.
brought
cent
It was
under
of the
the
oral
as in those
in fact this
Whatever
iron
is not so.
it may
be
is a most
which
often
due
important
occurs
to,
factor
in
there
is
in the
idiopathic
riO
that
doubt
developmeist
steatorrhea.
However,
that
excessive
iron loss may
also play
a part.
Such
bleeding
or, theoretically,
from
increased
excretion
In the two patients
B. B. and E. C., the amount
dose.
Furtherbore
had
the
a profuse
have
a
hut
of absorption
hypochromic
there
of
no
its whom
of
anemia
is some
iron loss may
iron.
of iron they
.
by mouth.
never
been
might
absorptiots,
failure
of the
idiopathic
of irois
who
We considered
the possibility
that the patietsts
with steatorrhea
high intake
of phosphate
in their
diet, causing
itsterference
w-ith
in
of radioiron
as low- in those
control
not
steatorrhea
iron
has
absorptiois
often
does
with
as much
steatorrhea
they
w-ith
dose
to treatment.
with
pancreatic
steatorrhea,
in
idiopathic
since
response
a severe
idiopathic
of bow-el
is defective,
contrast
utilization
apoferrit.in
with
of the
may
to Grartick
protein
patients
in
steat.orrhea
the production
of this specific
show
a disturbance
of protein
metabolism.
The
presence
of an excess
of fat within
This
according
of the
that
experimetits
of iron.
How-ever,
It is possible
of iron.
of our
absorption
ab-
evidence
occur
from
appeared
to
absorb
daily on the basis of the radioactive
irots test should
be sufficient
to keep
them
in iron
balance,
yet both
have
had recurrent
atiemia
w-hile maintaining
oral iron treatment.
Neither
appears
to have sufficietst
blood
loss to account
for
the
occult
iron
deficiency.
blood
have
B.
been
B.
occult
bleeding
from the
of every
oral dose would
Excessive
with labeled
iron
iron
tissues
body.
have
an
however,
of the
increased
cotsclude
have
been unable
the development
has
negative.
scaist.y
menstrual
periods
E. C., a male
gastrointestitsal
allow- for a loss
patietit,
atsd
has
tract,
w-hereas
of some
15 ml.
repeated
had
only
a 7 per
of blood
tests
for
intermittent
cent utilization
per day.
excretion
is unfortunately
impossible
to measure
adequately
as the radioactive
iron is not evenly
distributed
throughout
the
The
suggestion
that
some
patieists
excretion
remains
therefore
that
excessive
loss, either
to detect,
of anemia
or through
in some
itscreased
instances.
with
idiopathic
steatorrhea
at present
hypothetic.
through
some
bleeding
excretion,
must
play
One must,
which
we
a part
in
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
132
IRON
Further
evidetsce
st.eatorrhea
who
Noise
of these
food.
Fecal
active
is true
this
have
isot
pat.ietsts
is furnished
utilized
recoveries
face
ots
developmetst
the
three
patients
deficiency
than
2 per
(M.
One
STEATORRHEA
by
iron
more
made
to remain
free
low- absorption.
of
IN
developed
iron in the red cells was
for the other two it. would
steatorrhea
the
for
METABOLISM
H.)
(E.
cent.
of the
show-ed
a fair itsdication
appear
possible
anemia
is precipitated
pat ient
otse
of the oral (lose
from
the stools.
good
globulin.
response
hypochromie
of iron appeared
us the
Tise only
abnormality
us plasma
rise
w-ith
was
Treatment
with
obtained
blood
found
with
t.he
by
mouth
iron.
iron
patients
loss.
thais
to
was
We
1 per
cent
recovered
investigation
cases,
The
unable
steatorrhea.
less
was
Such
of radio-
years
even in
subjects,
the
remainder
extetssive
H.).
after
absorbed.
If this
with idiopathic
from
oti
M.
taken
amount
such
in w-hom
aisd
iron
intravenous
the
l)y excessive
anemia
idiopathic
L.,
dose
for many
as in normal
defect
in idiopathic
st.eatorrhea
w-ould render
compensate
for any itscreased
demands
for iron.
Not every
patietst
who fails t.o absorb
iron is suffering
studied
oral
that
absorption
have
W.
of the amount
for some patients
from signs
of iron deficiency
It may therefore
be that,
of hypochromic
with
Ham.,
ineffective
however,
are
was
a
but
a
rare.
Nb.
ml.
tn//O0
/6
Serwn
/5,
/4.
ml
/2jug/ioo
irort
Fe,-ro’s
daily
Salj/v.600mgs
/3.
12’
/1
10
9,
Li
8
iVlrotv
7tat
2500
7
tngs.
6
S
4
1
2
3
4
$
6
7
8
9
/0
/1
/3
/2
/4
Motttks
FIG.
spouse
6-13.
to
t neat
\V., ‘female,
ment
aged 36.
vi t ii intravenous
Idiopathic
iron after
steatorrhea
failure
to
and
hypochromic
respond
to
iron
anemia.
h
mout
ReIs.
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
J.
The
greater
BADENOCH
utilization
AND
of iron
SHEILA
given
to
T.
the
133
CALLENDER
fasting
subjects
suggests
that
if
patients
with idiopathic
steatorrhea
are treated
with iron by mouth
it is more
likely
to be effective
if given
between
meals
rather
than
after
food.
In practice,
however,
even this fails to ensure
that sufficient
iron is absorbed
and, in contrast
to
Wintrobe,9
we
steatorrhea
and
have
found
that
hypochromic
the
anemia
majority
of
ultimately
patients
require
with
idiopathic
parenteral
treatment
SUMMARY
The
patients
chromic
absorption
and utilization
of radioactive
with
steatorrhea
and a control
group
anemia
without
steatorrhea
and three
The patients
dose given
by
treatment
with
mouth.
with
idiopathic
steatorrhea
This is in keeping
with
iron has been studied
in sixteen
of twelve
patients
with
hyposubjects
without
anemia.
showed
their
a poor absorption
of the test
poor clinical
response
to oral
iron.
There
is some evidence
to suggest
not be the sole factor
involved
in the
that
poor
development
SUMMARIO
Le absorption
patientes
con
e utilisation
steatorrhea,
in
anemia
hypochromic
Le patientes
con
experimental
IN
de
patients
radioactive
de controlo
esseva
studiate
de dece-duo
per
via
oral.
Ist.e
concorda
con
clinic
a tractamento
oral con doses
de ferro.
Ii ha alicun
indicios
que le itsadequate
absorption
responsabile
pro
may
in dece-sex
patieistes
con
sin st.eatorrhea,
e in tres individuos
sin anemia.
steatorrhea
idiopathic
monst.rava
basse
absorption
administrate
sol factor
in such
anemia.
INTERLINGUA
ferro
gruppo
Ut1
absorption
of the
le disveloppamento
in
del
br
tal
del
magre
dose
responsa
patientes
es le
non
anemia.
REFERENCES
1 HAHN,
P. F.,
BALE,
W. F., Ross,
J. F.,
absorption
by gastro-intestinal
feeding.
J. Exper.
Med. 78: 169,
DUBACH,
R., CALLENDER,
S. T. E., AND MOORE,
metabolism.
VI. Absorption
of radioactive
mias of varied
etiology.
Blood
3: 526, 1948.
C. F.,
HAWKINS,
and
HUFF,
R. L.,
Treatment
129,
C. V., DUBACH,
and ferric radio-active
6
1944.
OLIVER,
R.:
samples.
FRAZER,
Use
Brit.
A. C.,
glucose
and
141, 1952.
8
GRANICK,
S.:
AND
W. T.:
iron.
COOKE,
intravenous
J. H.:
LAWRENCE,
M.,
AND
tract;
influence
1943.
C. V.: Studies
iron in patients
G. H.:
WHIPPLE,
of
in
anaemia,
iron
with
and
with
ane-
transportation
fever
and
and
Refractory
hypochromic
Lancet
2: 387, 1950.
A test
Radio-
anoxia
anaemia
for red cell production.
Acta
1952.
R.,
iron
MOORE,
755,
AND
with
C. A.,
TOBIAS,
7:
haemat.
A. L. P.,
PEENEY,
steatorrhoea.
\V.
BALFOUR,
active
iron
antecedent
by human
of a scintillation
J. Radiol.
26:
from
Ferritin;
the
its
AND
subjects
gamma
H. K.:
ROBERTS,
and
(logs. J.
by
t.he estimation
counter
for
G., AND
intestine
THOMPSON,
small
and
significance
Absorption
Clin.
of ferrous
Investigation
of iodine’3’
23:
in
liquid
663, 1953.
J. M.,
FRENCH,
urea
V.,
MINNICH,
THOMAS,
upper
properties
in the
for
M.
sprue
D.: The
syndrome.
iron
metabolism.
Henry
Kimpt.on,
absorption
Clin.
Sc.
Chem.
Rev.
38: 379, 1946.
WINTROBE,
M.
M.:
Clinical
Hematology,
Ed.
3, London,
1951,
of
11:
p. 475.
From www.bloodjournal.org by guest on June 15, 2017. For personal use only.
1954 9: 123-133
Iron Metabolism in Steatorrhea: The Use of Radioactive Iron in Studies of
Absorption and Utilization
J. BADENOCH and SHEILA T. CALLENDER
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