IX. EFFECTS OF DEFICIENCY 207 



these chanjies wove aggravated and pre-existing leucopenia progressed to a 

 leucoeyte eount of less than 500 per enbie miUimeter. Dramatic sympto- 

 matic improvement and return of temperature to normal occurred within 

 48 hours after institution of PGA therapy, followed by rise in the leucocyte 

 count and subsequent return of all hematologic values to normal. The evi- 

 dences of severe illness seen in this patient arc similar to those observed in 

 cases of advanced sprue or idiopathic steatorrhea and bear a close resem- 

 blance to the toxic effects of PGA antagonists, such as aminopterin. 



4, Megaloblastic Anemia of Infancy 



For some reason, perhaps related to the wider use of processed baby 

 foods, this condition has been seen more commonly in the United States 

 than in Great Britain or the European continent It is to be distinguished 

 from the normoblastic anemia occurring in marasmic infants and, in fact, 

 children afflicted with megaloblastic anemia are usually well nourished The 

 age of development of the blood changes, which include leucopenia and 

 thrombocytopenia as well as anemia, is usually between 6 months and 2 

 years. Apparently the condition may result from direct or "conditioned" 

 deficiency of either PGA or vitamin B12 . Sporadic case reports of this type 

 of anemia and its response to liver extract injection appear in the literature 

 prior to the advent of PGA and B12 . In the writer's experience with several 

 cases seen before PGA or B12 became available, all responded to liver in- 

 jection, whether of crude or purified type. 



The first clear demonstration of the efficacy of PGA in the treatment of 

 megaloblastic anemia of infancy was made by Zuelzer'''' and Zuelzer and 

 Ogden.'"" These authors stated that the effect of PGA was indistinguishable 

 from that produced by liver extract in certain cases, but that in others 

 PGA was effective after failure of response to liver injection. Similar obser- 

 vations have been made with reference to vitamin B12 by Luhby and 

 associates'"""^ who obtained responses to PGA or to institution of a diet 

 of whole milk and vegetables after failure to respond to vitamin B12 , and 

 by Woodruff and associates,'^" who reported three instances of megaloblastic 

 anemia of infancy, one of which responded to PGA after no effect from B12 , 

 whereas the other two were treated successfully with B12 by injection. 



>"5 W. W. Zuelzer, ./. Am. Med. Assoc. 131, 7 (1946). 



"« W. W. Zuelzer and F. N. Ogden, Am. J. Diseases Children. 71, 211 (1946). 



'" A. T.. Luhby, Health Center J. (Ohio State University) 2, 35 (1948). 



'^* A. L. Luhby and C. A. Doan, Proc. Conf. Preservation Fanned Elements and Pro- 

 teins Blood, Harvard Medical School, Boston (January, 1949). 



'■« A. L. Luhby and W. K. Wheeler, Health Center J. (Ohio State T'niversity) 3, 1 

 (1949). 



'''' C. W. WoodrulV, II. W. Kipy, J. ('. Peter.son, and W. J. Darby, Pediatrics 5, 723 

 (1949). 



