IT HAS been known for many years that anemia is frequently present in chronic liver disease, especially in cirrhosis of the liver. The etiology, however, has been obscure and has been the subject of considerable discussion. Since the anemia is often macrocytic in type, as first noted by Gram, in 1883,1 and subsequently confirmed by others,* it was only natural that a deficiency in the anti-pernicious-anemia factor be suspected. This explanation, however, has been largely discredited because of the lack of response to liver extract † and because the bone marrow is rarely megaloblastic in character.‡ In addition, it has been shown by Schiff and coworkers 15 that extracts made from cirrhotic livers are able to produce a hematological remission in patients with pernicious anemia.
In 1904 Bleichroeder first described the occurrence of red bone marrow in the femur of patients with cirrhosis and made the statement that "in