Macrocytic Anemia of Pregnancy

The association of anemia with pregnancy is well recognized. In this country the anemia is commonly due to iron deficiencies and is hypochromic. In the tropics a macrocytic, hyperchromic anemia of pregnancy has attracted attention and has been the subject of many recent investigations. Its counterpart in the temperate climates, the macrocytic or so-called pernicious anemia of pregnancy, has been considered a relatively rare dyscrasia.', The macrocytic anemia of pregnancy was first recognized over a century ago when Channing2 reported ten fatal cases. In 1919 Osler7 differentiated the so-called pernicious anemia of pregnancy from typical Addisonian anemia by pointing out that when recovery from the former disease took place it was permanent and the woman might escape it in subsequent pregnancies. In macrocytic anemia of pregnancy the peripheral blood picture may vgry from one identical with that of true pernicous anemia to one lacking all characteristic features of this anemia.1 13 On the other hand, examination of the bone marrow reveals pictures identical with those found in true Addisonian pernicious anemia and clearly indicates that macrocytic anemia of pregnancy has for its immediate cause arrested maturation of the megaloblasts. The two features which may be relied upon for the certain diagnosis of macrocytic anemia of pregnancy are the appearance of megaloblasts in the peripheral blood and the finding of a megaloblastic change in the bone marrow.1 If the peripheral blood picture is not diagnostic, bone marrow biopsy by means of sternal puncture is necessary or some cases will be missed. The following features serve to differentiate the macrocytic anemia of pregnancy from the true Addisonian pernicious anemia: the presence of free hydrochloric acid in gastric juice either without or after histamine injection, a lower frequency and the degree of macrocytosis and