December 1957

Megaloblastic Anemia in "Alcoholic" Cirrhosis

Author Affiliations

Chicago; Omaha; Chicago

From the Medical Services, Veterans' Administration West Side Hospital, Chicago, and Veterans' Administration Hospital, Omaha, and the Department of Medicine, University of Illinois College of Medicine.

AMA Arch Intern Med. 1957;100(6):870-880. doi:10.1001/archinte.1957.00260120014003

Introduction  Macrocytic anemia is common in patients with hepatic disease.1-11 As early as 1883 an increase in the mean diameter of the erythrocyte was observed in "icterus catarrhalis."12 There have been numerous references 1-11 to this phenomenon, but its mechanism remains incompletely understood. Most investigators agree that this macrocytosis is not caused by a deficiency of the "hematopoietic principle" 13 and is not associated with megaloblastosis of the bone marrow.8,14,15The most frequent abnormality of erythropoiesis in cirrhosis of the liver is normoblastic hyperplasia.8,14,15 It has been emphasized that this occurs even in the absence of bleeding and can be related to the shortened life span of the erythrocyte in this disease.16 Occasionally "macronormoblasts" 8 as large as megaloblasts are present in the bone marrow of cirrhotic patients, but these cells otherwise have morphological features typical of normoblasts. Nevertheless, megaloblastic anemia in patients with cirrhosis

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