Iron-resistant anaemia and latent rickets in schoolchildren.

Of thirty children, aged between one and four years, with active rickets examined by Findlay (1909), only nine were anaemic, and he concluded that the anaemia was due to secondary complications of the rickets. Hess (1929) states that anaemia is usually found in advanced rickets, but is not characteristic. Parsons (1934) says that anaemia is in no sense a symptom of rickets, although a degree of nutritional anaemia is not unusual, because a diet which is defective in one factor is likely to be defective in others. McDonough and Borgen (1937) studied thirty children, aged between six months and three years, with active rickets. Of the nineteen uncomplicated cases, six had haemoglobin values below 60 per cent., whilst only three had values above 80 per cent. Of the eleven complicated cases, six had haemoglobin values below 60 per cent. (two being below 40 per cent.), whilst none had values above 80 per cent. The ' complications ' were poor diet, cleft palate, upper respiratory infections, otitis media and suppurative adenitis. Since these authors regard only values below 60 per cent. haemoglobin as indicating anaemia, they conclude that the anaemia seen in rickets is due rather to secondary infection or lack of other nutritional factors than to lack of vitamin D. If 80 per cent. be taken as the minimal normal haemoglobin value for the young child, their figures show only three rachitic children with normal values. It appears that rachitic children are often, but not always, anaemic. It has not been possible to find any description of anaemia in late rickets or in latent rickets. The work to be described here shows that existence of ironresistant anaemia in school-children, associated with latent or chemical rickets, and the therapeutic results seem to indicate a close connexion between the anaemia and the rickets.