Hypochromic anemia

Hypochromic anemia is a generic term for any type of anemia in which the red blood cells (erythrocytes) are paler than normal. (Hypo- refers to less, and chromic means color.) A normal red blood cell will have an area of pallor in the center of it; it is biconcave disk shaped. In hypochromic cells, this area of central pallor is increased. This decrease in redness is due to a disproportionate reduction of red cell hemoglobin (the pigment that imparts the red color) in proportion to the volume of the cell. Red blood cells will also be small (microcytic), leading to substantial overlap with the category of microcytic anemia. The most common causes of this kind of anemia are iron deficiency and thalassemia.

Hypochromic anemia was historically known as chlorosis or green sickness for the distinct skin tinge sometimes present in patients, in addition to more general symptoms such as a lack of energy, shortness of breath, dyspepsia, headaches, a capricious or scanty appetite and amenorrhea.

Historical understanding

Pandar
Now, the pox upon her green-sickness for me!
Bawd
'Faith, there's no way to be rid on't but by the way to the pox. Here comes the Lord Lysimachus disguised.
Shakespeare (attrib). Pericles Prince of Tyre[1]

In 1554, German physician Johannes Lange described the condition as "peculiar to virgins". He prescribed that sufferers should "live with men and copulate. If they conceive, they will recover." The name "chlorosis" was coined in 1615 by Montpellier professor of medicine Jean Varandal from the word "Chloris" (Greek: χλωρις) meaning "greenish-yellow," "pale green," "pale," "pallid" or "fresh". Both Lange and Varande claimed Hippocrates as a reference.

In addition to "green sickness", the condition was known as morbus virgineus ("virgin's disease") or febris amatoria ("lover's fever"). Francis Grose' 1811 Dictionary of the Vulgar Tongue defined "green sickness" as: "The disease of maids occasioned by celibacy."[2]

In 1681, English physician Thomas Sydenham classified chlorosis as a hysterical disease affecting not only adolescent girls but also "slender and weakly women that seem consumptive." He advocated iron as a treatment: "To the worn out or languid blood it gives a spur or fillip whereby the animal spirits which lay prostrate and sunken under their own weight are raised and excited".

Daniel Turner in 1714 preferred to term chlorosis "the Pale or White Sickness ... since in its worst State the Complexion is rarely or ever a true Green, tho' bordering on that Hue". He went on to describe it as "an ill Habit of Body, arising either from Obstructions, particularly of the menstrual Purgation, or from a Congestion of crude Humours in the Viscera, vitiating the Ferments of the Bowels, especially those of Concoction, and placing therein a depraved Appetite of Things directly preternatural, as Chalk, Cinders, Earth, Sand, &c". One of his case studies was that of an 11-year-old girl who was found, on investigation, to have been eating large quantities of coal.[3]

Chlorosis is briefly mentioned in Casanova's Histoire de ma vie: "I do not know, but we have some physicians who say that chlorosis in girls is the result of that pleasure onanism indulged in to excess".

In 1841, the Bohemian doctor and pharmacist Albert Popper published a treatment for Chlorosis containing Vitriolum martis (sulfuric acid and iron) and Sal tartari (potassium carbonate) in Österreichische medicinische Wochenschrift which was republished and refined in the following years.[4][5][6][7][8]

In 1845, the French writer Auguste Saint-Arroman gave a recipe for a treatment by medicinal chocolate that included iron filings in his De L'action du café, du thé et du chocolat sur la santé, et de leur influence sur l'intelligence et le moral de l'homme[9] and in 1872, French physician Armand Trousseau also advocated treatment with iron, although he still classified chlorosis as a "nervous disease".[10][11][12]

In 1887, physician Sir Andrew Clark of London Hospital proposed a physiological cause for chlorosis, tying its onset to the demands placed on the bodies of adolescent girls by growth and menarche. In 1891, Frank Wedekind's play Spring Awakening referenced the disease. In 1895, University of Edinburgh pathologist Ralph Stockman built upon experiments demonstrating that inorganic iron contributed to hemoglobin synthesis to show that chlorosis could be explained by a deficiency in iron brought on by loss of menstrual blood and an inadequate diet. Despite the work of Stockman and the effectiveness of iron in treating the symptoms of chlorosis, debate about its cause continued into the 1930s. A character in T. C. Boyle's The Road to Wellville suffers from chlorosis, and the narrator describes her green skin and black lips.

In 1936, Arthur J. Patek and Clark W. Heath of Harvard Medical School concluded that chlorosis was identical to hypochromic anemia.[13]

Acquired forms

Hypochromic anemia may be caused by vitamin B6 deficiency from a low iron intake, diminished iron absorption, or excessive iron loss. It can also be caused by infections (e.g. hookworms) or other diseases, therapeutic drugs, and lead poisoning. One acquired form of anemia is also known as Faber's syndrome. It may also occur from severe stomach or intestinal bleeding caused by ulcers or medications such as aspirin or bleeding from hemorrhoids.[14]

Hereditary forms

It can also occur in certain forms of congenital developmental disorders, like Benjamin syndrome. It is also caused by thalassemia.

See also

Notes

  1. ↑ William Shakespeare (and possibly George Wilkins). Pericles Prince of Tyre, Act 4, Scene 6: A room in the brothel. First published 1609.
  2. ↑ 1811 Dictionary of the Vulgar Tongue by Francis Grose
  3. ↑ Turner, Daniel (1714). De Morbis Cutaneis: a treatise of diseases incident to the skin. London. pp. 90–91, 94.
  4. ↑ von Raimann, Johannes Nepomuk (17 July 1841). "Vitriolum Martis artefactum und Sal Tartari gegen Chlorosi". Österreichische medicinische Wochenschrift (Braumüller und Seidel, Vienna) 3 (29): 676–677.
  5. ↑ Schmidt, Carl Christian (1842). Jahrbücher der in- und ausländischen gesammten Medicin, Volume 35. Leipzig. p. 198.
  6. ↑ Dierbach, Johann Heinrich (1843). Die neuesten Entdeckungen in der Materia Medica: für praktische Aerzte geordnet, Volume 2. Heidelberg. pp. 1267–1268.
  7. ↑ "On the Mode of prescribing and preparing Pills composed of the Sulphate of Iron and Carbonate of Potass". The Medical Times: A Journal of English and Foreign Medicine, and Miscellany of Medical Affairs (J. Angerstein Carfrae, Essex Street, Strand, London) 13: 255. 28 March 1846.
  8. ↑ Anton, Karl Christian (1857). Vollständiges, pathologisch geordnetes Taschenbuch der bewährtesten Heilformeln fuer innere Krankheiten:Mit einer ausfuehrlichen Gaben- und Formenlehre, so wie mit therapeutischen Einleitungen und den noethigen Bemerkungen ueber die specielle Anwendung der Recepte. Leipzig. p. 209.
  9. ↑ Louis E. Grivetti, "From Aphrodisiac to Health Food: A Cultural History of Chocolate" Karger Gazette 6 no. 68.
  10. ↑ Guggenheim, KY (1995). "Chlorosis: the rise and disappearance of a nutritional disease" (pdf). The Journal of Nutrition 125 (7): 1822–5. PMID 7616296.
  11. ↑ Disease of Virgins; Green Sickness, Chlorosis and the Problems of Puberty by Helen King
  12. ↑ The appetite as a voice, by Joan Brumberg, pages. 164-165.
  13. ↑ Patek, Arthur J.; Heath, Clark W. (April 25, 1936). "Chlorosis" (PDF). Journal of the American Medical Association 106 (17): 1463–1466. doi:10.1001/jama.1936.02770170029010.
  14. ↑ Miale JB (1982). Laboratory Medicine: Hematology. (6th ed.) The CV Mosby Company, St. Louis ISBN 1-125-44734-6

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