Observations on Megaloblastic Anaemias After Primidone

Abstract

DiscussionAlthough mid-diastolic apical murmurs may be heard in cases of anomalous pulmonary venous drainage (Gardner and Oram, 1953; Whitaker, 1954), a confident diagnosis of mitral stenosis was made in this patient because of the presence of an enlarged left atrium fluoroscopically, and a well-marked opening snap clinically. In view of the grave condition of the patient it was decided to perform a mitral valvotomy before undertaking any special investigations such as cardiac catheterization. The findings at subsequent cardiac catheterization confirmed the presence of partial anomalous pulmonary venous drainage into the right atrium via the superior vena cava.In a patient with mitral stenosis the presence of anomalous pulmonary venous drainage would probably add to the disability by increasing the pulmonary artery pressure. Relief of the mitral stenosis would be expected to result in improvement in the patient's condition, though perhaps not to the same extent as in a patient with normal pulmonary venous drainage. The result in this case has been excellent and most gratifying.Taussig (1947), Snellen and Albers (1952), and Whitaker (1954) noted that the typical " figure-of-8 " or " cottageloaf" cardiovascular shadow was diagnostic of total anomalous pulmonary venous drainage into a left superior vena cava. Grishman et al. (1951) reported a case of partial anomalous pulmonary venous drainage, and the teleradiogram reproduced in their report showed the typical " figureof-8" appearance. However, as the difference in oxygen content between blood from the right atrium and the femoral artery was only 0.5 vol. %, which might be within the range of experimental error, it is possible that their patient in fact had total pulmonary venous drainage into a left superior vena cava. The normal arterial oxygen saturation in their patient would not exclude this possibility, as a similar finding was noted in a proved case by Gardner and Oram (1953). In the case reported here, although only part of the venous drainage of the lungs was into the left superior vena cava, the typical " cottage-loaf " cardiovascular shadow was present and was explained by the additional presence of tricuspid incompetence with subsequent increased prominence of the superior vena caval shadow. Summary A case is reported of the association of mitral stenosis and partial anomalous pulmonary venous drainage into a left superior vena cava. An excellent result was obtained by mitral valvotomy.The radiological appearance was suggestive of total drainage of pulmonary veins into a left superior vena cava, and was explained by the additional presence of tricuspid incompetence. I thank Dr. K. Shirley Smith, in whose department the cardiac catheterization was performed, and Mr. J. R. Belcher for permission to record this case.

Folic-acid Studies in Megaloblastic Anaemia Due to Primidone

“…We It is well known that a megaloblastic anaemia may develop in patients being treated with barbiturate-like anticonvulsants such as phenytoin sodium (Badenoch, 1954;Hawkins and Meynell, 1954), primidone (Fuld and Moorhouse, 1956), and, very occasionally, other barbiturates (Hobson, Selwyn, and Mollin, 1956). The cause of the anaemia is uncertain.…”

Clinical pharmacology of anticonvulsant compounds

“…71 Megaloblastic anemias have been reported from primidone. 34 It has also been reported to increase the frequency in number of petit mal seizures. 46 Chemically, primidone resembles phenobarbital quite closely.…”

Lymphadenopathy and megaloblastic anaemia in patient receiving primidone.

“…Anaemia due to a disturbance of folic acid metabolism has occasionally been reported after the administration of various hydantoin derivatives, barbiturates, or primidone (Badenoch, 1954;Fuld and Moorhouse, 1956;Hawkins and Meynell, 1958 ;Chanarin, Laidlaw, Loughridge, and Mollin, 1960). Macrocytosis, in the absence of overt anaemia, has been reported in epileptics receiving anticonvulsants (Hawkins and Meynell, 1950 precursors in the marrow were of the eosinophil series.…”