Mild Hereditary Spherocytosis--A Family Study

MEGALOBLASTIC MADNESSMBRmJ 1845 the patient's mental symptoms as being due to the " ulcer type " or that he is being " difficult" after the operation.Finally, it is emphasized that the diagnosis is difficult to establish in many cases in spite of a healthy clinical suspicion.Present-day " normal " levels of serum vitamin B12 are inadequate to cope with a wider concept of deficiency of the vitamin, but blind administration is to be deprecated unless injections are to be continued for life if the patient improves. SummaryAttention is drawn to the pre-macrocytic (? pre- megaloblastic) state, and six cases are presented to illustrate the pitfalls in diagnosis.Apart from the mental state, an abnormal E.E.G. may be the only positive finding and suggest exclusion of the diagnosis.Much larger doses of vitamin B12 are needed when treating this type of case, and care must be taken to ensure that an associated encephalopathy is not missed in a patient who presents with severe anaemia.Attribu- tion of the mental symptoms to the anaemia may result in undertreatment, with subsequent cerebral demyelina- tion as the physician's reward.It is probable that both exogenous and endogenous factors may modify the body's need and demand for vitamin B12.The role of smoking as a possible factor in the production of syndromes other than tobacco amblyopia is worth future consideration.Our present concept of normal levels of the vitamin needs constant re-scrutinization and evaluation in order that treatment may be planned on a scientific basis.