The Hematopoietic and Goitrogenic Effects of Cobaltous Chloride in Patients With Sickle Cell Anemia

Four children with sickle cell anemia were treated with cobaltous chloride. In each case there was an initial satisfactory hematopoietic response. This response could not be sustained with prolonged therapy, and in 3 children the hemoglobin concentration dropped below time pre-treatment values. All 3 children in whom thyroid function was evaluated developed enlargement of the thyroid gland. One developed severe myxedema, and 2 developed laboratory evidence of depressed thyroid function. Thyroid biopsies were performed in 2 and showed extreme hyperplasia. The clinical and laboratory findings reverted to normal when cobalt was withdrawn. It seems clear that cobaltous chloride is a goitrogenic agent in man. The anemia which recurs with prolonged therapy is unexplained. It may be secondary to hypothyroidism or to other causes. Indiscriminate use of cobalt as a hematinic should be avoided.