Folic Acid Deficiency in Sickle-Cell Anemia

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Abstract
ALTHOUGH the development of megaloblastic bone-marrow changes in the course of chronic hemolytic anemias was first described nearly thirty years ago1 only during the past decade has increasing emphasis been placed on this complication. Megaloblastic change has now been reported in association with both congenital and acquired hemolytic states, including hereditary spherocytosis,2 3 4 5 6 7 8 9 10 11 12 thalassemia,13 14 15 16 17 18 the hemoglobinopathies,19 20 21 22 23 24 25 26 27 28 hemolytic anemias in patients with positive Coombs tests2 , 18 , 29 and paroxysmal nocturnal hemoglobinuria.30 In the great majority of these reports direct evidence for either folic acid or vitamin B12 deficiency has been incomplete or absent, and therapeutic responses to huge "pharmacologic" doses of these agents . . .