Megaloblastic anemia probably caused by defective utilization of folinic acid.

By FARm 1. FIAuRANI, GEORGE WANG AND L. M. T0cANrINs I HE COMMON types of megaloblastic anemias usually res1)ond well to vitamin B-12 or folic acid but there are some which respond incompletely or not at all to these antianemic agents. In 1936, Israel and \Vilkinson referred to these megaloblastic anemias which are refractory to liver extract as “Achrestic n1 ‘ Since then a number of cases have been described but only in a few instances have the underlying biochemical defects been elucidated. One example of this type of anemia is Di Guglielmo syndrome, a megaloblastic anemia the metabolic tietect of which has not been defined. \Villsa described a few cases of megaloblastic anemias that did not respond to pure liver extract or vitamin B-12, but responded to crude liver extract. Up to the present time it i0 not clearly