Marasmic kwashiorkor anemia. III. Hemoglobin oxygen affinity.

Oxygen-hemoglobin dissociation curve, 2,3-diphosphoglycerate (2,3-DPG), and adenosine triphosphate (ATP) have been studied in marasmic kwashiorkor before re-feeding, after re-feeding, and in control children. P 50 and 2,3-DPG level are normal on admission, but high after re-feeding. Patients studied on admission were separated into 2 groups according to whether they presented active erythropoiesis (group I) or erythroblastopenia (group II). In group I, the sum 2,3-DPG + ATP correlates with the hemoglobin level. In group II, the sum 2,3-DPG + ATP correlates with the blood pH but not with the hemolobin level. It is suggested that marasmic kwashirokor anemia is an adaptation to a reduced metabolic activity. The hematological picture could proceed in 2 stages in this disease. In a first stage, the erythropoiesis is normal or increased because of the existence of a decreased red cell life span; a low hemoglobin level is observed, but there is no apparent hypoxia. At a more advanced stage of the disease, the tissue metabolism falls dramatically, the erythropoiesis is no loner stimulated, and the erythrocyte volume decreases notably.