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Three patients are described, and they provide further evidence that deficiency of folic acid and vitamin B12may sometimes affect small intestinal function. Malabsorption of both xylose and vitamin B12returned to normal in one patient after treatment of a megaloblastic anaemia due to dietary deficiency of folic acid. Impaired absorption of vitamin B12was corrected by vitamin B12therapy in the other two patients. The initial cause of the vitamin B12deficiency in one patient was not apparent, but she was taking Gynovlar 21, which may have been an aetiological factor. In the third patient the small intestinal defect was secondary to pernicious anaemia, and in a group of 98 other patients with pernicious anaemia intrinsic factor did not improve vitamin B12absorption in six, and only partially corrected absorption in 30. The significance of these observations is discussed.

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SYNOPSIS Folic acid deficiency with the picture of a megaloblastic bone marrow may develop in haemolytic anaemia, and, on the other hand, both vitamin B12 and folic acid deficiency may produce signs of haemolysis. As the correct interpretation of a positive antiglobulin reaction associated with megaloblastic erythropoiesis is particularly important, the effect of deficiency of vitamin B12 and folic acid on the results of the test was investigated in 32 patients with vitamin B12 or folic acid deficiency and a positive antiglobulin reaction was obtained in ten. There was no correlation between the result of the test and the degree of anaemia, and there was no significant difference between the incidence of positive results associated with deficiency of vitamin B12 or folic acid. In determining the significance of a positive result, the time interval before agglutination occurs is sometimes of greater value than the strength of the reaction or the result of the gamma globulin neutralization test.In both the acquired and hereditary types of haemolytic anaemia, the demands of increased red cell production may result in folic acid deficiency and a megaloblastic bone marrow (Chanarin, Dacie, and Mollin, 1959). It is important, therefore, to look for evidence of associated haemolytic disease in patients with megaloblastic erythropoiesis. As deficiency of both vitamin B12 and folic acid reduces the erythrocyte life span, resulting in a low haptoglobin level (Owen, Carew, Cowling, Hoban, and Smith, 1960) and sometimes an increase in unconjugated bilirubin in the serum, the diagnosis of a primary haemolytic disorder may be difficult to determine initially.The result of the direct antiglobulin test is of particular importance in the diagnosis of acquired auto-immune haemolytic anaemia. However, a positive result is not absolutely specific (Dacie and Lewis, 1963), and there has been one detailed report of a patient in whom a positive antiglobulin test was produced by pernicious anaemia (Selwyn and Alexander, 1951). In order to clarify the interpretation of a positive reaction in patients with megaloblastic erythropoiesis, we have investigated the effect of vitamin B12 and folic acid deficiency on the results of the test.