Clinical and laboratory studies of 22 patients with megaloblastic anemia.

Clinical and laboratory studies of 22 patients with megaloblastic anemia were reported herein. The patients were grouped on the basis of pathogenesis of megaloblastic anemia. Group A: 12 patients with idiopathic megaloblastic anemia. Group B: 10 patients with secondary megaloblastic anemia. In 5 patients megaloblastic anemia was associated with gas trectomy, in 3 patients with operation of small intestine and in 2 patients with drugs. The common presenting symptoms were palpitation and general fatigue. The erythrocyte count was ranged between 860,000 and 4,980,000 per mm3. Patients with severe anemia mostly showed leucopenia and thrombocytopenia. When anemia was severe, promegaloblasts and basophilic megaloblasts were recognized in bone marrow. The serum iron was usually normal or raised, and high levels of LDH were recognized. The Schilling test for 14 cases revealed vitamin B12 absorption ratio to be so low as 0.346.1 per cent. Hematological findings were rapidly improved by administration of vitamin B12 in all cases except 2 cases with severe heart failure. There are not so many megaloblastic anemia in Japan. So-called perni cious anemia reported first by Addison and Biermer has seldom been reported and only few cases are reported annually. This might be attributable not only to the racial difference1 but also to the fact that most Japanese people use habitually multivitamin tablets containing vitamin B12 and folic acid. Since the number of patients with secondary megaloblastic anemia caused by gastrectomy, intestinal operation and drugs, has been gradually increasing in