Document jR9YVZwLQobZRkEXwmG6ayr9

September 21 I9 4.O Dr, Carlos Ottolina Municipal a Reducto, 6I4. Caracas, Venezuela Dear Doctor Ottolinaj I have received your letter of August 50th, and a little later the slides which you sent for examination, I enclose herewith a notation as to our findings on the slides. ...... The considerable quantity of stippling found in the smears is indicative of some type of unusual condition, and one wonders, of course, as to what could be responsible for this picture. It seems highly improbable that lead exposure has anything to do with it* It is not possible from the information which you have given me to determine anything concerning the background of this condition. The laboratory report, as you have called It, has recognized that stippling is not necessarily indicative of lead absorption and that in many Instances it has nothing to do with lead. Therefore one would have to consider this case, and any others of similar type which might .develop, rather carefully. First of all in the absence of symptoms, one would scarcely be justified in taking immediate action. What one should do here I think, Is to look carefully Into the question of whether this man had had any actual or unusual lead exposure. If it is quite clear that he has not had such exposure, nothing need be done about the matter. Further slides could be obtained for examination as a means of determining what level of stippling is common in this m a n 's blood and how frequently it occurs in figures of this type. We have a number of men who have been working for years who show rather unusual levels of stippling most of the time. We do not regard these seriously unless they show some sudden or progressive change. As indicated In one of the articles which I sent you, we find stippling frequently and, indeed, almost regularly in normal blood. For this reason we are in the habit of making quantitative oounfls of stippled cells, expressing these in the number found in fifty fields of definite size and character. With our equipment fifty fields represents approximately 12500 erythryco basis we find normal persons running from 1 to 12, and sometimes more per fifty fields. The average of a large number of observations is approximately k stippled cells per fifty fields. On this basis you will see that your case is somewhat beyond the usual normal levels, and yet from time to time we find persons who give high values of this kind, even though they have no exposure to lead compounds* I am expecting to be in South America soon, and my plana involve my being in Venezuela in about the middle of November or perhaps a little later. You will undoubtedly hear from me in advance of my coming to your city, and I shall look forward to seeing you and talking over problems of this type. Meantime I think it is wise to point out that if you are satisfied that the mixing equipment is good and that it is operating properly, you need not make any dramatic or sudden changes in the personnel as a consequence of variations of this type. It is better to go slowly and carefully, and not to disturb the personnel too much. If the work is done properly and carefully, most of the anxiety concerning it will die down, and the operati ns can be carried out smoothly and without difficulty. regards, I am With kindest personal Cordially yours, RAK;is Robert A. Kehoe, M.D