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RICHARD A. MARSHALL, M.D.; JAMES H. JANDL, M.D.

AMA Arch Intern Med. 1960;105(3):352-360.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Anemias associated with frank megaloblastic changes in the bone marrow are usually caused by a deficiency of either cyanocobalamin (vitamin B₁₂) or folic acid. The clinical differentiation of these deficiencies is almost entirely circumstantial and often difficult. The presence of cyanocobalamin deficiency is almost certain when a megaloblastic anemia is associated with combined system disease of the spinal cord and is probable when the secretion of gastric intrinsic factor is defective. The latter association may be suspected or established, in order of increasing certainty, by the demonstration of (1) gastric achlorhydria, (2) gastric achylia, (3) failure to absorb oral radioactive cyanocobalamin unless this is accompanied by an intrinsic factor preparation.¹ Occasionally the diagnosis of vitamin B₁₂ deficiency is facilitated by obtaining a history of total gastrectomy or, more rarely, of long-standing vegetarianism.² Circumstantial clinical evidence of folic-acid deficiency is less specific than that of cyanocobalamin deficiency and diagnosis is usually . . . [Full Text PDF of this Article]

Author Affiliations
Boston

From the Thorndike Memorial Laboratory, Second and Fourth Medical Services (Harvard), Boston City Hospital, and the Department of Medicine, Harvard Medical School, Boston.

Footnotes
Submitted for publication Sept. 15, 1959.

This investigation was supported in part by the J. K. Lilly gift to the Harvard Medical School and by Research Grant No. HF-8798 from the National Institutes of Health, Public Health Service.

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