Observations on patients with addisonian pernicious anemia have appeared to us to demonstrate that the immediate basis of the anemia is a "conditioned" defect of nutrition. Thus, patients suffering from pernicious anemia are seemingly unable to derive from food some substance essential for normal function of bone marrow. The nutritional defect in such patients is apparently caused by the failure of a reaction which occurs in the normal individual between a substance in the food (extrinsic factor) and a substance in the normal gastric secretion (intrinsic factor). This conclusion is based on the following evidence derived from previous observations1 on cases of addisonian pernicious anemia:
The daily administration of (extrinsic factor) 200 Gm. of beef muscle is without significant effect on blood formation.
The daily administration of (intrinsic factor) from 150 to 300 cc. of normal human gastric juice is without significant effect on blood formation.
Castle WB, Ham TH. Observations on the Etiologic Relationship of Achylia Gastrica to Pernicious Anemia: V. Further Evidence for the Essential Participation of Extrinsic Factor in Hematopoietic Responses to Mixtures of Beef Muscle and Gastric Juice and to Hog Stomach Mucosa. JAMA. 1984;251(4):514–521. doi:10.1001/jama.1984.03340280064034
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