Correlation of Folate Deficiency with Alcoholism and Associated Macrocytosis, Anemia, and Liver Disease

Article1 June 1963Correlation of Folate Deficiency with Alcoholism and Associated Macrocytosis, Anemia, and Liver DiseaseVICTOR HERBERT, M.D., RALPH ZALUSKY, M.D., CHARLES S. DAVIDSON, M.D., F.A.C.P.VICTOR HERBERT, M.D., RALPH ZALUSKY, M.D., CHARLES S. DAVIDSON, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-6-977 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMacrocytosis 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...References1. GRAM C: Untersuchungen über die grösse der roten Blutkörperchen im Normalzustande und bei verschiedenen Krankheiten. Fortschr. Med. 2: 33, 1884. Google Scholar2. BIANCOJOLLIFFE AN: The anemia of alcohol addicts. Observations as to the role of liver disease, achlorhydria, nutritional factors and alcohol on its production. Amer. J. Med. Sci. 196: 414, 1938. CrossrefGoogle Scholar3. 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Blood 15: 244, 1960. CrossrefMedlineGoogle Scholar10. HERBERT V: The Megaloblastic Anemias, Grune & Stratton, Inc., New York, 1959. Google Scholar11. HERBERTZALUSKY VR: Folic acid deficiency in alcoholic cirrhosis. Amer. J. Clin. Nutr. 9: 246, 1961. Google Scholar12. HAM TH: A Syllabus of Laboratory Examinations in Clinical Diagnosis, Harvard University Press, Cambridge, 1950. Google Scholar13. BAKERHERBERTFRANKPASHERHUTNERWASSERMANSOBOTKA HVOISHLRH: A microbiologic method for detecting folic acid deficiency in man. Clin. Chem. 5: 275, 1959. CrossrefMedlineGoogle Scholar14. HERBERT V: The assay and nature of folic acid activity in human serum. J. Clin. Invest. 40: 81, 1961. CrossrefMedlineGoogle Scholar15. LEARHARRISCASTLEFLEMING AAJWWBEH: Serum vitamin B12 concentration in pernicious anemia. J. Lab. Clin. Med. 44: 715, 1954. MedlineGoogle Scholar16. ZALUSKYHERBERT RV: Urinary formiminoglutamic acid as test of folic acid deficiency. Lancet 1: 108, 1352, 1962. CrossrefGoogle Scholar17. DAVIDSONPOPPER CSH: Cirrhosis in alcoholics. Amer. J. Med. 27: 193, 1959. CrossrefMedlineGoogle Scholar18. MINOTMURPHY GRWP: Treatment of pernicious anemia by a special diet. JAMA 87: 470, 1926. CrossrefGoogle Scholar19. KRASNOWWALSHEZIMMERMANHELLER SEJRHJP: Megaloblastic anemia in "alcoholic" cirrhosis. Arch. Intern. Med. (Chicago) 100: 870, 1957. CrossrefGoogle Scholar20. HALL CA: The macrocytosis of liver disease. J. Lab. Clin. Med. 48: 345, 1956. MedlineGoogle Scholar21. KAPLANMOLLISON HPL: Red cell life span in nephritis and in hepatic cirrhosis. Clin. Sci. 12: 351, 1953. MedlineGoogle Scholar22. WATSON CJ: Hemolytic jaundice and macrocytic hemolytic anemia: certain observations in a series of 35 cases. Ann. Intern. Med. 12: 1782, 1939. LinkGoogle Scholar23. JANDL JH: The anemia of liver disease; observations on its mechanism. J. Clin. Invest. 34: 390, 1955. CrossrefMedlineGoogle Scholar24. JONESWEINSTEINETTINGERCAPPS PNIMRHRB: Decreased red cell survival associated with liver disease. Arch. Intern. Med. (Chicago) 95: 93, 1955. CrossrefGoogle Scholar25. SHEEHYBERMAN TWA: The anemia of cirrhosis. J. Lab. Clin. Med. 56: 72, 1960. MedlineGoogle Scholar26. HERBERTBAKERFRANKPASHERSOBOTKAWASSERMAN VHOIHLR: The measurement of folic acid activity in serum: a diagnostic aid in the differentiation of the megaloblastic anemias. Blood 15: 228, 1960. CrossrefMedlineGoogle Scholar27. BACHICOSCIAROSSI CGCM: Studio sul metabolisme dell'acido folico nella cirrosi epatica. Minerva Med. 50: 1348, 1959. MedlineGoogle Scholar28. CARTERHELLERSCHAFFNERKORN FCPGRJ: Formiminoglutamic acid (FIGLU) excretion in hepatic cirrhosis. Arch. Intern. Med. (Chicago) 108: 41, 1961. CrossrefMedlineGoogle Scholar29. MERRITTRUCKNAGELGARDINERSILVERMAN ADDLRCM: The identification of urocanic acid in human urine and a comparison of N-formiminoglutamic acid (FGA) with urocanic acid (UA) excretion following L-histidine loading. Clin. Res. 8: 213, 1960. Google Scholar30. MERRITTRUCKNAGELSILVERMANGARDINER ADDLMRC: Urinary urocanic acid in man: the identification of urocanic acid and the comparative excretions of urocanic acid and N-formiminoglutamic acid after oral histidine in patients with liver disease. J. Clin. Invest. 41: 1472, 1962. CrossrefMedlineGoogle Scholar31. LEEVYGEORGEZIFFERBAKER CMWSHH: Pantothenic acid, fatty liver and alcoholism. J. Clin. Invest. 39: 1005, 1960. Google Scholar32. HERBERT V: Experimental nutritional folate deficiency in man. Trans. Ass. Amer. Physicians 75: 307, 1962. MedlineGoogle Scholar33. HERBERT V: Minimal daily adult folate requirement. Arch. Intern. Med. (Chicago) 110: 649, 1962. CrossrefMedlineGoogle Scholar34. HERBERT V: A palatable diet for producing experimental folate deficiency in man. Amer. J. Clin. Nutrit. 12: 17, 1963. CrossrefMedlineGoogle Scholar35. HERBERT V: Unpublished data. Google Scholar36. HERBERT V: Current concepts in therapy: megaloblastic anemia. New Eng. J. Med. 268: 201, 368, 1963. CrossrefMedlineGoogle Scholar37. SULLIVANHERBERT LWV: Suppression of hematopoiesis by alcohol. J. Clin. Invest. 42: (June), 1963. MedlineGoogle Scholar38. SNYDERVOGELSHULMAN RWHMP: Inhibition of liver alcohol dehydrogenase by folic acid. Fed. Proc. 22: 183, 1963. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, MassachusettsFrom the Thorndike Memorial Laboratory, Second and Fourth (Harvard) Medical Services, Boston City Hospital, and the Department of Medicine, Harvard Medical School, Boston.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.Requests for reprints should be addressed to Victor Herbert, M.D., Thorndike Memorial Laboratory, 818 Harrison Avenue, Boston 18, Massachusetts. 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DESFORGES, M.D.Formiminoglutaminsäureausscheidung bei chronischen Lebererkrankungen und ihre Bedeutung für eine Folsäure-Vitamin B12-BehandlungThrombocytopenia in AlcoholicsJOHN LINDENBAUM, M.D., R. LESLIE HARGROVE, M.D.Megaloblastic Anemia Possibly Induced by Triamterene in Patients with Alcoholic Cirrhosis Two Case ReportsFRED L. LIEBERMAN, M.D., JOSEPH R. BATEMAN, M.D.Repeated alcoholic intoxication compared with continued consumption of dilute ethanol in experiments with rats on a marginal dietTREATMENT OF ALCOHOLISM-MODERN CONCEPTSFolates in Human NutritionFolates in Human NutritionThe relation of hyperlipemia to hemolytic anemia in an alcoholic patientCirrhosis and hepatoma in alcoholics.Megaloblastic and transitional megaloblastic anemia associated with chronic liver diseaseFolic acid deficiency in cirrhosis of the liverHematopoietic Factors in Liver DiseasesFolic acid clearances and basal serum folate levels in patients with thyroid diseaseSymposium on Folic Acid DeficiencyMetabolic Effects of Alcohol on the Liver 1 June 1963Volume 58, Issue 6Page: 977-988KeywordsAlcoholismAlcoholsAnemiaCirrhosisHemoglobinHospital medicineLiverMedical servicesResearch laboratoriesStatistical data Issue Published: 1 June 1963 PDF DownloadLoading ...