Q J Med 1971; 40: 331-340
© 1971 Association of Physicians
research-article |
The Effects of Chemotherapy on Iron, Folate, and Vitamin B12 Metabolism in Tuberculosis
From the Departments of Haematology and Medicine, Royal Postgraduate Medical School Hammersmith Hospital, London, W. 12
Received 27 October 1970 Iron, folate, and vitamin B12 studies were carried out in 33 patients with tuberculosis before treatment and after three months' chemotherapy. Initially seven patients (21 per cent) were anaemic. These seven patients all had advanced active disease and the anaemia appeared to be due to a combination of defective iron utilization, iron deficiency, and folate deficiency.
In the group as a whole, folate deficiency was extremely common since low serum folate levels occurred in 45 per cent, low red-cell folate levels in 15 per cent, positive Figlu tests in 56 per cent, and megaloblastic erythropoiesis in 55 per cent. Urocanic acid excretion was raised in 16 per cent of patients suggesting liver dysfunction. The serum iron was subnormal in 66 per cent and iron was absent from the marrow in 34 per cent. There was no correlation in the individual patient between serum iron or T.I.B.C. and bone-marrow iron findings. The haemoglobin and E.S.R. were the only findings related to the severity of the disease.
After three months' chemotherapy there was a significant over-all rise in haemoglobin, though the seven patients were still anaemic. There were also significant rises in serum folate and iron levels and falls in both Figlu and urocanic acid excretions. However, megaloblastic erythropoiesis was still present in 61 per cent and iron deficiency in 30 per cent of bone marrows examined.
The mean serum vitamin B12 level fell from 425 pg/ml to 348 pg/ml with treatment, but no over-all change in vitamin B12 absorption could be detected.