Cyanocobalamin, Ascorbic Acid and Pteroylglutamates in Normal and Megaloblastic Bone Marrow

The B₁₂ activity as estimated by Lactobacillus leichmannii, the folic-acid-like activity by Streptococcus faecalis (F.A.A.) and the ascorbic acid concentration have been determined in the blood and buffy coat of bone marrow of normal subjects, 10 patients with pernicious anemia in relapse, a group of patients with non-Addisonian megaloblastic anemia and some patients with iron deficiency.

A correlation between the serum B₁₂ and the plasma ascorbic acid and their respective levels in bone marrow was observed. The marrow and serum B₁₂ levels in prenicious anemia were abnormally low, but they did not differ from a group of 5 patients with hypochromic normoblastic anemia who had both low serum and marrow levels. The concentration of F.A.A. in the marrow of patients with pernicious anemia was reduced, but it was felt that this was more likely a manifestation of the megaloblastic anemia rather than a causative factor.

One of six patients with megaloblastic anemia of pregnancy had no detectable deficiency, while the other five had reduced B₁₂, folic acid and ascorbic acid concentrations. The possible therapeutic implications are discussed.

There was a significant reduction in the bone marrow concentration of ascorbic acid in all patients with megaloblastic anemia.