IRON AND ASCORBIC ACID FOR ANAEMIA IN CHILDREN MEDBRII JOUNA77control group, but the increase over their own initial haemoglobin values was not significant.(d) An analysis of the haemoglobin figures of those children whose initial haemoglobin level was less than 80% showed that out of 26 in the control series 15 (57.7%) still had haemoglobin figures of less than 80% at the second examination; of those receiving ascorbic acid alone, 19 had haemoglobin levels below 80% at the first examination, and at the second examination 13 (68.4o%) , 1935) and Edinburgh (Davidson et al., 1942), have clearly demonstrated the frequency with which anaemia occurs in infants, school-children, and women, both pregnant and non-pregnant. The anaemia is almost universally of the hypochromic type, which responds excellently to iron therapy. It leads to a feeling of fatigue and exhaustion, to a loss of appetite, and to a reduction in efficiency. In the case of the infants it has been shown to be associated with an increased liability to infection. The family doctor should constan-tly be on the watch for the development of anaemia in his patients. The improvement in their general well-being which will rapidly result from the administration of the ferrous salts of iron will amply reward him for the time spent on making the necessary examinations. For the prevention of anaemia, reliance should be placed primarily on securing an adequate intake of iron by instructing the patient to eat sufficient quantities of the foodstuffs which are particularly rich in the mineral. By so doing the intake of other important factors connected with haematopoiesi's-e.g., protein and vitanmins B and C-will be coincidently improved. In this connexion we wish to draw attention to the value of national wheatmeal bread made of 85% extraction flour. Its content of iron is 0.7 mg. per oz., compared with 0.3 mg. per oz. for white bread made from 70% extraction flour. On an average intake of 6 oz. of bread daily an addition of more than 2 mg. of iron daily is consumed. Investigations which will be published shortly suggest that this increment during the past eighteen months has already made a significant contribution to the reduction of anaemia in school-children. Nevertheless, under wartime conditions it may on occasion be necessary to supplement the diet with medicinal iron.The investigations reported in this paper clearly indicate that the administration of iron in doses of approximately one-third of that usually prescribed for curative treatment can significantly improve the haemoglobin levels of school-children.The increases shown in the values. In the municipal-school children in Edinburgh the average haemoglobin figure was found to be 80%. Accordingly approximately half of the children had a haemoglobin level above this figure and half below it. It would be unreasonable to expect such small doses of iron to affect materially haemoglobin levels of normal or only slightly subnormal ranges. A study of individual cases showed this to be the case. It should be n...

AimTo assess if routine monitoring of vitamin C in long term parenteral nutrition (PN) patients should be routinely carried out, following a case report of a child with clinical vitamin C deficiency.MethodsVitamin C is an essential water soluble nutrient that cannot be synthesised or stored by humans.1 It is a potent antioxidant with anti-inflammatory and immune- supportive roles,1 Vitamin C levels are depleted in critically ill patients, those with restricted diets, smokers, and those with severe digestive disorders. The stability of micronutrients in PN bags is assumed but rarely confirmed, although a decrease in vitamin C content has been observed when there is a long delay between preparation and packaging.2 The patient, a five year old child stable on long term established full PN presented with a one month gradual reduction in mobility, refusal to weight bear, intermittent temperatures, raised CRP and asymptomatic hypercalcaemia on routine bloods. Investigations included bone profile, vitamin D, and parathyroid hormone levels, and routine sepsis screening. Following the extensive work up for systemic disorders and multiple conversations with orthopaedic and radiology specialists, it was discovered that the patient had bilateral metaphyseal irregularities, which were felt to be in keeping with recognised radiological appearances seen in severe vitamin C deficiency. As a result of this her PN bags were made manufactured and analysed in house quality control laboratory using a method involving UV –vis spectrophotometer to analyse the rate of oxidative decomposition of vitamin C within the bags.ResultsIn the United Kingdom children on long term PN programmes are routinely monitored for selected micronutrient deficiency, but not routinely vitamin C. The vitamin C was increased in the PN to three times the baseline dose for this patient, and a dramatic improvement in the patients symptoms were observed within 5 days, and radiological improvement was noted within 6 weeks after commencing treatment. Unfortunately baseline vitamin C levels were not obtained prior to starting treatment, but levels one month later still showed a significant clinical deficiency. The test bags that were analysed within the laboratory showed that on manufacture the bags contained 48.34 mg/L of ascorbic acid, but by 48 hours this had decreased to 8.5 mg/L.ConclusionVitamin C in PN is at significant risk of degradation by oxidation. Awareness of signs and symptoms of micronutrient deficiency and vigilance of micronutrient deficiencies not routinely measured in children on parenteral nutrition is important. Also more research is required into the oxidation rate of vitamin C in PN to establish how much is required within the PN bag to ensure the recommended daily intake in a PN dependent patient.ReferencesCarr AC, Rosengrave PC, Bayer S, Chambers S, Mehrtens J, Shaw GM. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Crit Care. 2017;21(1):300. Published 2017 December 11...