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Brabin, Bernard (2021) 'The possible effects of iron loss from bloodletting on mortality from pneumonia in the nineteenth century'. Journal of Clinical Epidemiology, Vol 138, pp. 139-146.
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Abstract
Objective
To estimate iron losses and disease severity following 19th century bloodletting in patients with pneumonia.
Study design and setting
Benefits of bloodletting in pneumonia patients were contested during the 19th century. Although large blood volumes during infection were removed there was no systematic data collection assessing efficacy and knowledge of iron composition of blood was rudimentary. This observational analysis of historical data quantifies iron losses in pneumonia cases in relation to disease severity.
Results
Based on one detailed case series average blood volume removed for survivors was 830 ml (range 114 - 2272 ml), and mean recovery times were shorter in patients bled within 2 days of illness (p<0.001). Average iron removed was 446 mg with phlebotomy done ≤ 2 days of illness presentation and 347 mg after >2 days of illness (p=0.012). Across several European hospitals average case fatality in pneumonia patients receiving phlebotomy was higher than in those treated without phlebotomy (19.9% vs 12.8%, OR 1.55, 95% CI 1.38-1.74, P<0.001).
Conclusion
Variable efficacy for bloodletting could at least in part be explained by altered iron status.
| Item Type: | Article |
|---|---|
| Subjects: | QU Biochemistry > Biochemistry of the Human Body > QU 100 Body composition QV Pharmacology > Hematologic Agents > QV 183 Iron. Iron compounds WB Practice of Medicine > Therapeutics > WB 381 Phlebotomy. Bloodletting. Leeching WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 202 Pneumonia (General or not elsewhere classified) WZ History of Medicine. Medical Miscellany > History, By Period, Locality, etc. > WZ 60 19th century |
| Faculty: Department: | Education |
| Digital Object Identifer (DOI): | https://doi.org/10.1016/j.jclinepi.2021.06.018 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 08 Jul 2021 15:41 |
| Last Modified: | 20 Jun 2023 14:28 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/18149 |
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