The disparity between the subjective improvement, the reticulocytosis, and the increase in hematocrit early in the course of treatment of pernicious anemia has been observed but is incompletely understood.1,8 In view of the prompt clinical improvement and early reticulocytosis it seems probable that the lag in hematocrit response does not indicate delayed hematologic improvement but more likely indicates a proportionate increase in plasma volume during the initial response of the red cell volume, and so the hematocrit is little affected.Despite studies by many workers on blood volume in pernicious anemia, no characteristic abnormal pattern in this disease has been established. Consequently, no suitable explanation for the lag in rise of the hematocrit has been obtained.
Review of Literature
Smith,2 in 1900, studied seven cases of pernicious anemia and, using a carbon monoxide absorption and dilution method, found the blood volume to be normal or even elevated.
MASSIE RW. Relationship Between Red Cell and Plasma Volume During Recovery from Pernicious Anemia. AMA Arch Intern Med. 1959;103(4):593–597. doi:10.1001/archinte.1959.00270040079009
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