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August 5, 1944


JAMA. 1944;125(14):990. doi:10.1001/jama.1944.02850320048020

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To the Editor:—  The rare macrocytic anemia of pregnancy is a serious and incompletely understood disease. Some writers have considered it a form of pernicious anemia, but most observers have been impressed particularly by its resemblance to the hemolytic anemias. My purpose in this communication is to report some recent observations of mine which suggest a plausible explanation for the pathogenesis of this disease.Long ago Ottenberg and Thalhimer (J. M. Research33:213, 1915) in transfusion experiments on cats observed that, while the first transfusions were well tolerated, when the transfusions were repeated the recipients eventually developed acute hemolytic reactions followed by a severe erythroblastic anemia. Similarly, in human Rh negative patients who have become sensitized to the Rh factor it has been observed that transfusions of Rh positive blood not only fail to produce a rise in hemoglobin but may cause acute hemolytic transfusion reactions followed by an

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