Liver function studies before and after alcohol ingestion Serum

Anemia is a frequent finding in alcoholic patients for many reasons. One of the major causes is folate deficiency with associated macrocytosis and megaloblastic erythropoiesis (2). Whether the nutritional folate deficiency (presumed to be mainly from inadequate ingestion of folate-containing foods) in these patients is the sole cause of the macrocytosis and megaloblastic anemia, or whether other factors, among them alcohol, contribute to the anemia, has been a subject for much speculation. The concept that macrocytic anemia of liver disease may be the result of interference with blood formation has been entertained for at least 3 decades (3, 4). The frequent association of leukopenia and thrombopenia and the finding of "spontaneous" reticulocytosis in this anemia (upon admission to the hospital or soon thereafter) has been long noted (3-6), suggesting, among other possibilities, that cessation of alcohol ingestion removed a hematopoietic suppressant (6). Recent observations indicate that the minimal daily oral requirement for folic acid is in the range of 50 yg (7, 8), an amount exceeded many times by routine hospital diets and diets previously employed in studies of folate-deficient patients. Thus, the question of whether the hematologic improvement in alcoholics with megaloblastic anemia given no specific therapy is due to ingestion of folate (from the hospital diet or just be-