Correlation of Folate Deficiency with Alcoholism and Associated Macrocytosis, Anemia, and Liver Disease
- VICTOR HERBERT, M.D.;
- RALPH ZALUSKY, M.D.; and
- CHARLES S. DAVIDSON, M.D., F.A.C.P.
- Requests for reprints should be addressed to Victor Herbert, M.D., Thorndike Memorial Laboratory, 818 Harrison Avenue, Boston 18, Massachusetts.
Excerpt
Macrocytosis has been observed frequently in association with cirrhosis since 1884 (1). The concomitant presence of macrocytosis, anemia, and cirrhosis, usually in association with alcoholism, sometimes with a macronormoblastic or even a megaloblastic bone marrow, has been frequently noted in the medical literature (2-10).
In 1938, noting no correlation between macrocytosis and severity of liver damage, Bianco and Jolliffe (2) concluded: "In view of these findings we are inclined to regard the macrocytosis of the alcohol addict not as a manifestation of inability on the part of the liver to store a hematopoietic principle, but as an extrinsic deficiency of
This 100-word excerpt has been provided in the absence of an abstract.
Acknowledgment
We are indebted to Mrs. Rebecca Fisher Dunn, Mrs. Barbara Bean Mummey, Miss Brenda Conti, and Mrs. Nancy Cunneen Boardman for the microbiologic assays, to Misses Geneva Daland, Carola Kapff, and Louise Jaskiel for the hematologic studies, and to Mrs. Charles Jewell for major assistance in gathering data.
Statistical analysis of the data was made by Dr. Hugo Muench and Miss Rasma Klints of the Department of Biostatistics, Lemuel Shattuck Hospital.
Addendum
The designations mµg and µµg have recently been changed to nanograms (ng) and picograms (pg) by the International Union of Pure and Applied Physics. The old designations are used in this article.
Summario in Interlingua
Esseva studiate 70 patientes con alcoholismo e varie grados de dysfunction hepatic. De istes solmente 5 (i.e. 7%) habeva normal nivellos de folato seral de 7 o plus mµg/ml, determinate per medio de Lactobacillus casei. Novem (i.e. 13%) habeva diagnosticamente indecisive nivellos de 5 a 6,9 mµg/ml; 25 (i.e. 36%) habeva nivellos de 3 a 4,9 mµg/ml (fortemente suggestive de carentia de folato); e 31 (i.e. 44%) habeva nivellos de infra 3 mµg/ml (indicative de carentia de folato). Omne le 6 patientes ex le gruppo con vivellos seral de folato de minus que 3 mµg/ml, in qui le urina esseva studiate pro formiminoglutamato post cargation a histidina, habeva anormalmente alte excretion de ille composito.
Macro-ovalocytos e un augmento del segmentation in le nucleos neutrophile esseva presente in le frottis de sanguine peripheric ab omne le patientes con nivellos seral de folato de infra 3 mµg/ml e ab le majoritate del patientes con nivellos seral de folato de inter 3 e 4,9 mµg/ml. In iste subjectos, quando aspiratos de medulla ossee esseva obtenite, illos esseva patentemente megaloblastic o monstrava grande metamyelocytos e "macronormoblastos" como evidentia morphologic additional de carentia de folato (o de vitamina B12).
Le correlation inter le reducite nivellos seral de folato e le altere variabiles studiate esseva sequentemente: Pro recente alcoholismo, significative; pro macrocytosis (augmento del volumine corpuscular medie) e anemia (reducite valores pro hemoglobina), justo significative; pro cirrhosis e hepate grassiose o hepatitis, de signification marginal; e pro dieta, concentration medie de hemoglobina corpuscular, o nivello seral de vitamina B12, non establite (in le caso del dieta a causa del micre numero de subjectos con dieta de bon qualitate).
Article and Author Information
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From the Thorndike Memorial Laboratory, Second and Fourth (Harvard) Medical Services, Boston City Hospital, and the Department of Medicine, Harvard Medical School, Boston.
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This investigation was supported in part by research grant A-3853 from the National Institutes of Health, United States Public Health Service; the National Vitamin Foundation; the Nutrition Foundation, Inc., New York; and the United States Army Medical Research and Development Command, Department of the Army, Contract DA-49-193-MD-2013.
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- Received November 30, 1962.
- Accepted April 8, 1963.
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