Iron and Folate Metabolism in Tuberculosis

Abstract

Two groups of tuberculous patients, 50 treated and 18 untreated, were investigated for abnormalities of folate and iron metabolism. In 30% of the 68 patients the marrows showed obvious megaloblastic changes. Hypersegmented poly-morphs were seen in about one-third of the peripheral blood films, and serum folate levels below the lower limit of a control series were found in 35% of the patients. Figlu tests were positive in 47%, and red-cell folate levels were subnormal in 33% of the small unselected proportion of the patients tested. Folate deficiency was equally common among the treated and untreated patients, and its incidence bore no relation to the clinical extent of the disease or to the length or type of chemotherapy. Excess stainable iron was present in the erythroblasts of 19 (30%) of the 63 patients whose marrows were suitable for assessment. The iron granules were coarser than normal, were increased in number, and were often perinuclear in distribution. One patient showed obvious ring sideroblastic change. Increase in marrow iron was confined to patients receiving chemotherapy, and was particularly common in patients treated with isoniazid and P.A.S. for longer than six months, occurring in 16 (57%) of these 28 patients. Some of these patients also had raised serum iron levels and increased saturation of the iron-binding capacities. © 1966, British Medical Journal Publishing Group. All rights reserved.