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To the Editor.
—In a typical, well defined case of pernicious anemia, one sees at a glance the oversized erythrocytes, which are present even during remissions of the disease. During a relapse, in addition, megaloblasts are perceived. Piney believes that these large cells are representatives of certain intravascular cells of the embryonal liver persisting in this disease to adult life. Parenthetically, some children exhibit achylia, attributed by some observers to toxemias following infectious diseases. I believe that macrocytes should be looked for in these conditions. If Piney is right, pernicious anemia is present from intra-uterine life until middle age without symptoms. These large cells have a diameter of 15 to 18 microns. According to Gray, the usual diameter of the capillaries is 8 microns. They are smallest in the brain and intestine and largest in the bones and skin: 20 microns. It has been noted that improvement is last manifested
O'Drain TI. CAPILLARY CHANGES IN PERNICIOUS ANEMIA. JAMA. 1933;100(11):837. doi:10.1001/jama.1933.02740110049029
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