Macrocytic Anemia in Disease of the Liver

Duyn, John Van

doi:10.1001/archinte.1933.00160060013002

Cited by 20 publications

(4 citation statements)

References 11 publications

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“…Twenty-eight weeks preceding the observation period recorded in Table 4, the patient re- 4.60 99 60 to 120 gm. beef or 1 to 2 eggs daily 60 to 120 gm.…”

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confidence: 99%

“…beef or 1 to 2 eggs daily 19 60 to 120 gm. beef or 1 to 2 eggs daily 4 ceived a single dose of 10 units (2 cc.) of liver extract intramuscularly.…”

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confidence: 99%

“…occi or i lu c cyya uauy i.jj 60 to 120 gm. beef or 1 to 2 eggs daily4.81 60 to 120 gm. beef or I to 2 eggs daily Patient had received 10 units of liver extract intramuscularly twentyeight weeks preceding the beginning of this period; no other antianemic substance given.…”

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Liver Dosage in Pernicious Anemia

Seymour¹,

Heinle²,

Miller³

1941

N Engl J Med

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TREATMENT of patients with pernicious anemia by parenteral liver extract has become such a well-established procedure that it needs no further discussion. The usual method involves the administration of conveniently sized doses of liver extract at regular intervals of one, two, three and, occasionally, four weeks. The size of each dose and the interval between treatments must be regulated by the requirements of the patient as determined by observation in each case.Normal persons manufacture the hematopoietic principle effective in pernicious anemia by the interaction of intrinsic (gastric) factor and extrinsic (food) factor.1 This reaction presumably takes place in the intestinal tract,2 and the product of the interaction is recovered from the liver in the preparation of the liver extracts effective in the treatment of pernicious anemia. It has been thought that the liver might be a storehouse for the hematopoietic principle,38 and that its only function is to release this principle as the necessity arises. If it were possible for the liver to store the hematopoietic principle quantitatively without any excretion or destruction, it is conceivable that large amounts of liver extract might be administered over a short period to patients with pernicious anemia and thus enable them to remain in remission as long as if the same total dose of liver extract were given in the usual manner of smaller doses at regular, frequent intervals. Miller,7 in 1936, suggested this possibility and presented data showing that some such storage might take place. Strauss and Pohle8 sub-sequently presented similar data indicating that, although some storage may take place, patients with pernicious anemia generally do not remain in remission so long when treated with single massive doses as when they receive the same total dose in smaller amounts at spaced intervals.The observations reported here were made on 9 patients with pernicious anemia in remission and 13 patients with pernicious anemia in relapse.Six were men, and 16 were women. All had been observed at some previous time during both relapse and remission. The 9 patients in remission had been followed previously for ten to forty-six weeks during remission; during this time they received doses of liver extract at intervals of two or three weeks, and the individual requirement was ascertained. The 13 patients in relapse had also been followed from ten to forty-six weeks during a remission, so that their individual maintenance dosage of liver extract was similarly established. Subsequently, these 13 patients failed to keep scheduled appointments for treatment, so that when next seen they were in relapse, at which time the observations reported here were begun.For purposes of discussion, patients were arbitrarily considered to be in remission when the redcell count was 4,000,000 or more, with a hemoglobin of 90 per cent (14.0 gm. per 100 cc). Values less than these constituted a relapse. All patients had typical Addisonian pernicious anemia, including the usual blood findings, absence...

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“…Twenty-eight weeks preceding the observation period recorded in Table 4, the patient re- 4.60 99 60 to 120 gm. beef or 1 to 2 eggs daily 60 to 120 gm.…”

mentioning

confidence: 99%

“…beef or 1 to 2 eggs daily 19 60 to 120 gm. beef or 1 to 2 eggs daily 4 ceived a single dose of 10 units (2 cc.) of liver extract intramuscularly.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Liver Dosage in Pernicious Anemia

Seymour¹,

Heinle²,

Miller³

1941

N Engl J Med

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“…Wintrobe and Shumacker(16), reviewing forty-three cases of hepatic cirrhosis, note a 37% incidence of macrocytic hyperchromic anemia. Van Duyn (17) reports an 18% incidence in twenty-eight cases of hepatic cirrhosis. Malamos (18) reports that in each of twenty-four cases of diffuse liver disease studied, the mean diameter of the erythrocytes was increased by 0.6 -2.3 micra, together with a widening of the Price-Jones curve.…”

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confidence: 99%