Nutritional megaloblastic anemia associated with sickle cell states.

By ULFAR JONSSON, 0. STUART ROATH AND CHARLOTFE I. F. KIRKPATRICK BONE MARROW CHANGES suggestive or diagnostic of megaloblastic erythropoiesis have been recognized on a number of occasions in patients with hemolytic anemia. 4 ln many of these patients evalumation of a possible response to agents effective in megaloblastic anemias has not been possible because of concurrent transfusions or for other reasons. A few case reports have appeared in recent years where such a therapeutic trial has been made and a specific response has been obtained with a similar time sequence as would be expected in patients with megaloblastic anemia without coincident hemolytic anemia. A reversal to normoblastic erythropoiesis has usually been observed to occur in these cases following response to specific therapy. The present report deals with three cases of nutritional megaloblastic anemia which have been observed in patients with sickle cell disease or sickle cell-hemoglobin C disease. Other cases of megaloblastic anemia occurring in the course of hemolytic anemias are reviewed and possible etiologic relationships discussed.