In March 1992, 12 bone marrow transplant patients at the Fred Hutchinson Cancer Research Center received blood components from donors who were anti-HCV-nonreactive by first generation ELISA but whose serum later tested anti-HCV-reactive to a second generation ELISA. All these blood components were further tested for anti-HCV using a second-generation RIBA and for HCV RNA by polymerase chain reaction. Recipient sera were tested for HCV RNA prior to and following blood component infusion. Blood components from four donors were positive for HCV RNA. All recipients of HCV RNA-positive blood components became viremic on the first day tested post-infusion. In addition, two recipients of HCV RNA-negative blood components tested HCV RNA-positive both pre- and post-infusion. Viremia persisted up to the time of death or day 100 in five of the six patients who were HCV RNA-positive post-transplant. No HCV RNA-positive recipient developed symptomatic acute hepatitis, and only two had aminotransferase elevations consistent with chronic hepatitis. We conclude that HCV RNA-positivity in blood components accurately predicts transmission of virus. Infection with HCV did not adversely affect short-term patient outcome following bone marrow transplantation.

The relationship between plasma iron, transferrin saturation, and plasma iron turnover was studied in 53 normal subjects whose transferrin saturation varied between 17% and 57%, in 25 normal subjects whose transferrin saturation was increased by iron infusion to between 67% and 100%, and in five subjects with early untreated idiopathic hemochromatosis whose transferrin saturation was continually elevated to between 61% and 86%. The plasma iron turnover of all of these subjects ranged from 0.45 to 1.22 mg/dL whole blood/d. The mean values for the above-mentioned three groups were 0.71 +/- 0.17, 1.01 +/- 0.11, and 1.01 +/- 0.13 mg/dL whole blood/d, respectively. Most of this variation, estimated at 72% by regression analysis, was due to a direct relationship between transferrin saturation and plasma iron turnover. This effect was attributed to a competitive advantage of diferric over monoferric transferrin in delivering iron to tissues. This was confirmed by the demonstration of a more rapid clearance of diferric as compared to monoferric transferrin in an additional group of eight normal subjects. Calculations were made of the amount of transferrin reacting with membrane receptors per unit time. Allowance was made for the noncellular (extravascular) exchange and for the 4.2:1 preference of diferric over monoferric transferrin demonstrated in vitro. The amount of iron-bearing transferrin leaving the plasma to bind to tissue receptors for 53 subjects with a transferrin saturation between 17% and 57% was 71 +/- 13; for 25 subjects with a saturation from 67% to 100%, 72 +/- 12; and for five subjects with early idiopathic hemochromatosis, 82 +/- 11 mumol/L whole blood/d. There were no significant differences among these groups. These studies indicate that while the number of iron atoms delivered to the tissues increases with increasing plasma iron and transferrin saturation, the number of iron-bearing transferrin molecules that leave the plasma per unit time to bind to tissue receptors is relatively constant and within the limits studied, independent of transferrin saturation.

Daily infusion of a total parenteral nutrition (TPN) formulation containing 1 liter of 5.5% Travasol provides less than 0.1 milligrams of iron. By comparison, a formulation which includes a liter of 10% Travamin provides 2 milligrams of iron per day. To meet iron requirements in patients infusing formulations containing Travasol, iron was added as ferrous citrate. In in virto experiments, 74% of this iron was available to transferrin. In seven patients in whom in vivo availability was tested by red cell incorporation, the mean availability was 81%. Ferrous citrate is recommended as a safe, effective additive to TPN solutions for adult patients requiring iron supplements.

1. Iron absorption from maize (Zea mays) and sorghum (Sorghum vulgore) beer was more than twelvefold greater than from a gruel made from the constituents used to prepare the beer. 2. The effect of changes occurring during brewing were investigated. These changes include a decrease in the solid content, and the formation of 30 ml ethanol/l and 5 ml lactic acid/]. 3. The presence of solid material was found to inhibit Fe absorption markedly, especially when the solid content was 100 g/l or more. 4. The presence of ethanol potentiated Fe absorption but the effect was only modest in gruels with a high solid content. 5 Fe absorption from a 2 ml lactic acid/] solution was four-fold greater than from a hydrochloric acid solution of the same pH. When lactic acid was added to a gruel containing 200 8 solids/l the mean absorbtion rose from 0.4 to 1.2%. 6. In a direct comparison, Fe absorption from beer was significantly better than from a gruel of similar pH containing lactic acid. 7. The results suggest that at least three factors are responsible for the enhanced Fe absorption from maize and sorghum beer. These include the removal of solids during fermentation and the presence of ethanol and of lactic acid in the final brew. 8. In order to reproduce the way in which beer is brewed domestically in Fe containers, a study was done in which beer was prepared in the presence of Fe wire. Under such circumstances Fe was rapidly dissolved and the final Fe concentration of the brew was 89 mg/l. However, the nature of the Fecontaining compound or compounds was not elucidated.

1. Ventilation and cardiac frequency were measured during repeated treadmill exercise in three healthy subjects over 36 weeks, before, during and after iron-deficiency anaemia was produced and after iron treatment. The haemoglobin and 2,3-diphosphoglycerate concentrations and the oxygen-binding (P50) were measured. 2. There was an inverse relationship between the haemoglobin concentrations and the 2,3-diphosphoglycerate concentrations and the P50 values. 3. The mean cardiac frequencies during the fourth to tenth minutes of exercise showed a negative correlation with the haemoglobin concentrations in all three subjects, and the mean minute ventilations in two of them.

Previous human studies have shown that drinking tea during meals significantly inhibits the absorption of both food iron and medicinal iron. This study provides evidence from experiments with rats that the tannins in the tea are responsible for the inhibition, probably by forming non-absorbable complexes with the iron within the intestinal lumen. The molar ratio of tannin: iron is dependent on the pH, being 1:1 at pH 2,0 2:1 at pH 5,5 and 3:1 at pH 8,0. Since tannins are present in many vegetable foods the formation of such complexes may be a factor in the poor availability for absorption of much food iron.

1. Iron absorption from rice-containing meals was measured by red cell utilization of radioactive Fe in sixty-six volunteer multiparous Indian women. 2. In all the studies salt added during the cooking process was used as the carrier for supplemental inorganic Fe and ascorbic acid. 3. Intrinsic Fe in the rice and supplementary inorganic Fe were absorbed to the same extent, with a wide range of absorption values. 4. There was a striking difference between the mean absorption of a 3 mg dose of ferrous Fe given to fasting subjects in a solution containing 30 mg ascorbic acid and that of Fe in a rice meal (48.7 and 3.5% respectively). 5. When ascorbic acid was added during cooking there was a threefold increase in the absorption of both intrinsic Fe and supplementary Fe when a sufficient quantity (60 mg) was present. 6. It is concluded that the Fe nutrition of rice-eating communities could be improved significantly by the addition of ascorbic acid to the diet.

Summary. Common salt fortified with ascorbic acid or iron compounds became discoloured on storage, the reaction being accelerated by heat and humidity. Soluble iron compounds such as FeSO4 caused discoloration more readily than insoluble compounds such as ferric orthophosphate (FePO4). Fortification with both ascorbic acid and iron led to more rapid discoloration than fortification with either alone. Colour developed more rapidly in coarse salt than in refined commercial salt, while chemical NaCk developed a faint discoloration only under very hot and humid conditions. Discoloration was inhibited if starch was mixed with the salt: coarse salt mixed with 2.5% starch, 1.25% ascorbic acid and 0.1% iron as FePOI retained an acceptable appearance during storage under subtropical conditions (Durban) for more than I yr. A double isotope red cell utilization method was employed to assess the absorption of iron from maize porridge and from a standard rice meal cooked with fortified salt. The absorption of both the intrinsic food iron and the iron in the fortified salt was increased threefold if the salt contained 50 mg ascorbic acid as well as FePO4. The amount of iron absorbed was similar whether the salt contained 50 mg ascorbic acid and 4 mg iron as FePO4 or 50 mg ascorbic acid and 4 mg iron as FeSO4. It was concluded that crude common salt could be fortified with 0.1% iron as FePO, and 1.25% ascorbic acid and stored under all but the most extreme tropical conditions, provided that 2.5% starch was added to prevent the development of discoloration, and that such fortification would significantly improve the iron nutrition in countries where the staple food is rice or maize.

Summary.The absorption of iron from three staple vegetables was measured by the red cell utilization method in iron deficient subjects. The food iron had been labelled with 55Fe by the hydroponic cultivation method. In addition, 59Fe was added with or without carrier iron in the form of ferric ammonium citrate, prior to cooking. The constant relationship reported by others between the absorption of the two isotopes was confirmed, suggesting that the extrinsic iron and the food iron were absorbed from a common pool. The addition of ascorbic acid to maize porridge before cooking significantly enhanced the absorption of both the intrinsic and the added iron. However, no effect was noted with soya biscuits or with whole wheat bread (100% extraction). Evidence was obtained that these differences were due to the oxidative destruction of the ascorbic acid by the high temperatures required for baking. If, therefore, a feasible method were found for supplementing vegetable foodstuffs with ascorbic acid and inorganic iron, nutritional benefit would only be anticipated with uncooked or boiled foods.