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
KRASNOW SE, WALSH JR, ZIMMERMAN HJ, HELLER P. Megaloblastic Anemia in "Alcoholic" Cirrhosis. AMA Arch Intern Med. 1957;100(6):870–880. doi:10.1001/archinte.1957.00260120014003
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