Red Blood Cells

Cox IM, Campbell MJ, Dowson D. Magnesium and chronic fatigue syndrome [Letter]. Lancet 1991; 337: 1295.

Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet 1991; 337: 757-60.

Abstract: The hypothesis that patients with chronic fatigue syndrome (CFS) have low red blood cell magnesium and that magnesium treatment would improve the wellbeing of such patients were tested in a case-control study and a randomised, double-blind, placebo-controlled trial, respectively. In the case-control study, 20 patients with CFS had lower red cell magnesium concentrations than did 20 healthy control subjects matched for age, sex, and social class (difference 0.1 mmol/l, 95% confidence inteval [Cl] 0.05 to 0.15) In the clinical trial, 32 patients with CFS were randomly allocated wither to intramuscular magnesium sulphate every week for 6 weeks (15 patients) or to placebo (17). Patients treated with magnesium claimed to have improved energy levels, better emotional state, and less pain, as judged by changes in the Nottingham health profile. 12 of the 15 treated patients said they had benefited from treatment, and in 7 patients energy score improved from the maximum to the minimum. By contrast, 3 of the 17 patients said that they felt better (difference 62%, 95% CI 35 to 90), and 1 patient had a better energy score. Red cell magnesium returned to normal in all patients on magnesium but in only 1 patient on placebo. The findings show that magnesium may have a role in CFS.

Davies S. Magnesium and chronic fatigue syndrome [Letter]. Lancet 1991; 337: 1295.

Dunstan H, Roberts T, Donohoe M, McGregor N, et al. Bioaccumulated chlorinated hydrocarbons and red/white blood cell parameters. Biochemical and Molecular Medicine 1996; 58: 77-84 .

Abstract: The potential relationships between chlorinated hydrocarbon contamination in human serum and red/white blood cell profiles were investigated by multivariate techniques to assess the cellular response patterns to high and low organochlorine levels in the serum. Twenty-three healthy control subjects and fourteen patients with unexplained and persistent fatigue were divided on the basis of (a) high or low total organochlorine content, (b) high or low DDE (1,1-dichloro-2,2-bis(p-chlorophenyl) ethene) content, and (c) high or low HCB (hexachlorobenzene) content. Discriminant function analysis revealed that the groups with high organochlorine content had significantly different red/white blood cell profiles compared with the low organochlorine groups ((a) P < 0.017, (b) P < 0.015, and (c) P < 0.0002). As a variable, the percentage of neutrophils was the most important discriminant parameter for differentiating between the high and low total organochlorine groups. Thirteen of the fourteen fatigued patients were characterized as "high total organocholorine content" (P < 0.04). The red cell distribution width was elevated in the high DDE group (P < 0.04) and was the most important discriminant parameter for differentiating between the high and low DDE groups. The percentage of eosinophils and the hemoglobin content were both reduced in the high HCB group (P < 0.009, P < 0.003, respectively) and the percentage of eosinophils was the most important discriminant parameter for differentiating between the high and low HCB groups. Those patients with unexplained and persistent fatigue had significantly higher levels of DDE compared with the controls and had different specific blood cell responses to organochlorines compared with control subjects.

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Hinds G, Bell NP, McMaster D, McCluskey DR. Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome. Annals of Clinical Biochemistry 1994; 31 ( Pt 459-61.

Abstract: Red blood cell magnesium concentrations were measured in samples from 89 patients who fulfilled the diagnostic criteria for chronic fatigue syndrome and the results compared to those found in an age and sex matched group selected from the normal population. No significant difference was found. Six patients were further investigated using a magnesium loading test to determine if there was any evidence of magnesium deficiency associated with this disorder. None was found. There is therefore no indication for the use of magnesium therapy in the management of this condition.

Howard JM, Davies S, Hunnisett A. Magnesium and chronic fatigue syndrome. Lancet 1992; 340: 426.

Lloyd A, Wakefield D, Smith L, Isbister J, McGrath M, Collings A, Bajenov N. Red blood cell morphology in chronic fatigue syndrome [Letter]. Lancet 1989; 2: 217.

Lloyd A, Wakefield D, Smith L. Blood cell morphology in chronic fatigue sydrome [Letter]. Lancet 1989; 2: 805.

Mukerjee TM, Smith K, Maros K. Abnormal red-blood-cell morphology in myalgic encephalomyelitis [Letter]. Lancet 1987; 2: 328-9.

Richards RS, Roberts TK, Mathers D, Dunstan RH, McGregor NR, Butt HL. Erythrocyte Morphology in Rheumatoid Arthritis and Chronic Fatigue Syndrome: A Preliminary Study. Journal of Chronic Fatigue Syndrome 2000; 6: 23-35.

Richards RS, Roberts TK, Mathers D, Dunstan RH, McGregor NR, Butt HL. Investigation of Erythrocyte Oxidative damage in Rheumatoid Arthritis and Chronic Fatigue Syndrome Journal of Chronic Fatigue Syndrome 1999; 6: 37-46.

Roath S. Blood cell morphology in chronic fatigue syndrome [Letter]. Lancet 1989; 2: 805.

Simpson LO, Murdoch JC, Herbison GP. Red cell shape changes following trigger finger fatigue in subjects with chronic tiredness [CFS] and healthy controls. New Zealand Medical Journal 1993; 106(952): 104-7.

Abstract: AIMS. To investigate the possibility of a correlation between the percentage of nondiscocytic erythrocytes and muscle fatiguability in subjects with the symptom of chronic tiredness. METHODS. Sixty nine volunteers suffering from persisting or intermittent tiredness and 72 healthy controls provided 3-drop samples of venous blood for red cell shape analysis before and after inducing fatigue in the trigger finger muscles by repeatedly pulling the trigger of an antique revolver. Elapsed time and the number of pulls were recorded. A work index was calculated from the number of trigger pulls divided by the time in seconds then multiplied by the number of trigger pulls. RESULTS. Subjects with tiredness had fewer discoid cells (males 62.5% vs 69.2%, p = 0.029; females 65.8% vs 71.8%, p = 0.002) than controls. They also had fewer trigger pulls (males 62.3 vs 84.0, p = 0.003; females 29.5 vs 36.8, p = 0.042) and lower "work indices" (males 75.6 vs 104.7, p = 0.001; females 26.1 vs 39.6, p = 0.001) than controls at the first trigger pulling. After 5 minutes rest the number of trigger pulls for males was fewer than the controls (56.0 vs 64.2) but the difference was not significant, but the female values (24.3 vs 33.2) were significantly different (p = 0.008). Work indices for both sexes were significantly different from controls (males p = 0.020, females p = 0.001). CONCLUSIONS. The association of increased nondiscocytes and impaired muscle function could indicate a cause and effect relationship. This would be in agreement with the physiological concept of fatigue as a consequence of inadequate oxygen delivery.

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Simpson LO, Shand BL, Old AG. Blood rheology and myalgic encephalomyelitis: a pilot study. Pathology 1986; 18: 190-2.

Abstract: The blood rheology of EDTA-anticoagulated blood samples from blood donors and subjects considered to have myalgic encephalomyelitis was assessed by multiple shear rate viscometry and by multiple-pressure filterability. Although average viscosities of the two groups were different, the differences did not reach statistical significance. In contrast, the data from multiple-pressure filtration of whole blood showed significant differences between females at the lowest (2.5 cm of water) filtration pressure. It appears that the acute phase of the disorder is associated with changes in blood rheology which could impair microcirculatory blood flow. In contrast, the chronic state does not appear to be associated with rheological abnormalities.

Simpson LO. Chronic fatigue, viruses and depression [Letter]. Lancet 1991; 337: 564.

Simpson LO. Chronic tiredness and idiopathic chronic fatigue - a connection? New Jersey Medicine 1992; 89(3): 211-216.

Abstract: Evidence is adduced to support the proposal that pathological fatigue is a consequence of impaired capillary blood flow resulting in inadequate oxygen delivery, which is in accordance with physiological concepts of fatigue. Case reports are presented.

Simpson LO. Nondiscocytic erythrocytes in myalgic encephalomyelitis. New Zealand Medical Journal 1989; 102: 126-7.

Abstract: Blood samples from 102 volunteers who believed they suffered from myalgic encephalomyelitis were photographed in a scanning electron microscope at 500x. All identifiable cells were counted and classified on the basis of their shape. The frequency of each cell shape was expressed as a percentage of the total number of cells counted in the sample. The resulting data were compared with that from 52 healthy controls and 99 cases of multiple sclerosis which had been selected randomly by a computer from a panel of 229 cases in a concurrent study. Samples from subjects with myalgic encephalomyelitis had the lowest percentages of normal red cells and the highest incidence of cup forms. The results provide evidence that myalgic encephalomyelitis has an organic cause. Quantitative analysis of red cell shape may assist in the diagnosis of myalgic encephalomyelitis.

Wakefield D, Lloyd A. Pathophysiology of myalgic encephalomyelitis [Letter]. Lancet 1987; 2: 918-9.

Walden RJ. Magnesium and chronic fatigue syndrome [Letter]. Lancet 1991; 337: 1295.

Young IS, Trimble ER. Magnesium and chronic fatigue syndrome [Letter]. Lancet 1991; 337: 1094-5.

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