In many patients with low serum levels of vitamin B12, the absorption of the free vitamin has been normal. The present study, using a total body counter 57CoB12 absorption method that clearly separated those with intrinsic factor deficiency from controls, found that of 94 patients with low B12 levels and intact stomachs in whom the absorption of free and bound B12 was determined, 44 (47%) had normal absorption of both. However, 20 of the 94 (21%) with normal absorption of free B12 had low absorption of bound B12. The remainder (32%) had low absorption of both free and bound B12. All patients with high serum gastrin levels had low bound B12 absorption, but so did 21% of those patients with normal serum gastrin levels.
TABLE I. Absorption of Egg Yolk-Bound 57C0 Vitamin B,, Administered as an Omelette or an Eggnogreticulocyte count in myelodysplasia is compai-able to the values for healthy subjects (men and women) (see Table I).Some of the patients suffering from severe anemia in inyelodyaplasia received blood transfusions but these did not change significantly the reticulocyte count and HFR.In contra\t to a normal reticulocyte count, the niean HFR ratio and the r ratio are found to be higher in patients with myelodysplasia. Concerning the r ratio. the difference between the group of healthy donors and the group of patients with myelodysplasia is highly significant ( P < 0.001) (Table I) but the difference between the subgroups of myelodysplasia is not significant (data not shown).In myelodysplasia. the global count ofrcticulocytes is of little help iii the evaluation of bone inarrow activity. The discrepancy between a high ratio HFR and a normal reticulocyte count remains difficult to assess in myelodysplasia. Lofters et al. 141 have reported a case of preleukemia with in vitro evidence of abnormal reticulocyte maturation. The patient had marked reticulocytosis apparently caused by a delayed maturation of all the subgroups of reticulocytes. Lofters et al. wggest that this could be due to abnormal ribonucleic acid or to a quantitative or qualitative deficiency of ribonuclease.In our study, a higher r index ruggests an abnonnal reticulocyte maturation, with a prolonged survival of younger reticulocytes. fnllowed by a reticulocyte abortion. resulting in a normal or low reticulocyte count, these phenomena leading to a nonregenerative anemia. These data suggest that r could be evaluated as another indice of erythropoiesis in nonregenerative anemia in order to give further evidence of a putative myelodysplastic syndrome.
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