Three patients with cirrhosis of the liver, macrocytic anemia, and megaloblastic proliferation in the bone marrow have been described. All 3 patients gave histories of grossly deficient diets for many years and all 3 had free hydrochloric acid in the gastric juice. The latter finding was thought to be of particular significance from the diagnostic point of view in that it appeared to exclude the possibility of coexisting addisonian pernicious anemia. The clinical diagnosis of Laennec’s cirrhosis was confirmed by liver biopsies in 2 cases, and in both, the bone marrow morphology reverted to the normoblastic type on appropriate therapy.
The literature on the subject of macrocytic anemia in association with hepatic cirrhosis has been briefly reviewed and various theories as to its pathogenesis briefly discussed. Attention has been called to the fact that despite specific denials by many investigators, megaloblastic bone marrow is seen in some of these patients. The pathogenesis of this phenomenon has remained obscure, and the various etiologic possibilities are discussed.