Blood & Iron

Only a generation ago, anemia was both a common and a fashionable complaint. It was good for endless speculative chatter, because doctors understood little about it, and nearly every patient had his (or more often her) favorite patent nostrum. Last week, Salt Lake City's Dr. Maxwell Myer Wintrobe told a Manhattan audience of doctors how drastically the anemia story has changed in a mere three decades.

In the first place, Dr. Wintrobe emphasized, anemia is no longer recognized as a disease, but only as a symptom of some other disease. As a result, a whole class of so-called "primary anemias" is being dropped from medical thinking, e.g., pernicious anemia is now known to be a metabolic upset in which the system fails to make proper use of vitamin B12. Once the cause of this or practically any other anemia is tracked down, the underlying complaint can be treated and the symptom usually disappears.

"The diagnosis and treatment of anemia." says Dr. Wintrobe, "depends on an ounce of knowledge, an equal amount of understanding, and a pound of thoroughness." This thoroughness begins with determining the degree of anemia. Ordinary red blood-cell counts, Dr. Wintrobe insists, have a wide margin of error, and the only accurate test is the hematocrit method (his own invention), now being adopted by more and more hospitals.

After the degree of anemia, the doctor must find the cause. There is no excuse nowadays, Dr. Wintrobe contends, for a doctor who just picks a shotgun type of blood tonic from the medical advertisements and hopes for the best. Prescribing iron is merely treating the symptom, and often worthless: an adult male should get all the iron he needs from a normal diet, unless he is losing blood; so should a woman, barring unusual menstrual difficulties. The iron deficiency may be a clue which will lead the thorough physician to a kidney disorder, a liver infection, inflammation of the heart membrane, or even an unsuspected cancer.

Far from lightening the physician's burden, recent knowledge of the causes and cures in several types of anemia, Dr. Wintrobe holds, has made it heavier. But it has made things a lot better for the patient, provided the doctor uses that pound of thoroughness.

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