HEMATOLOGIC OBSERVATIONS IN PATIENTS WITH CHRONIC HEPATIC INSUFFICIENCY

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Abstract
A hematologic survey carried out in 30 patients with portal cirrhosis proved by liver biopsy or autopsy confirms the high incidence of macrocytic anemia previously descr. Reticu-locytosis which ranged up to 13.5% could not be explained by blood loss. The bone marrow of these persons was normally cellular or moderately hypocellular. In 11 there was moderate normoblastic hyperplasia. The 3 patients with megaloblastic maturation arrest had evidence of "extrinsic factor" deficiency. Plasmacytes were consistently increased to values as high as 23.5% in the sternal marrows of these patients. The degree of plasmacytosis correlated roughly with the degree of hyperglobul inemia, suggesting a cause and effect relationship of a similar nature to that observed in multiple myeloma. The macrocytic anemia failed to respond to liver extract and folic acid although there was an occasional spontaneous hematologic remission associated with a decrease in the severity of the cirrhosis. There was a significant hematologic response to liver extract or ground beef only in the 3 patients in whom extrinsic factor deficiency was suspected. The normoblastic bone marrow and lack of response to liver extract and folic acid in the majority of cases strongly suggests that the macrocytic anemia of chronic liver disease is produced by a metabolic defect entirely different from that responsible for pernicious and related macrocytic anemias.