IX. KFFKfTS OF DEFICIENCY 200 



stratcil ill tlu' trcalincnt of oiulcinic AnKMicau sprue."*'''"*'' PCIA llierapy in 

 throe patients with this form of sprue resulted in complete reversal of the 

 clinical manifestations, inehulins ji'lossitis, atrophy of the lingual papillae, 

 anorexia, weight loss, and diarrhea with high fecal fat.'^" Maximum reticulo- 

 cyte responses were noted in (> to 8 days, erythrocyte, leucocyte, and platc;- 

 let values returned to normal, and megaloblasts and abnormal granulo- 

 cytes disappeared from the bone marrow. A therapeutic response was 

 obtained in one case of sprue after the administration of the pure PGA 

 conjugate, pteroyltriglutamic acid, in a daily dose of 4.9 mg., whereas 

 another patient responded to the administration of a concentrate of pteroyl- 

 heptaglutamic acid containing in each daily dose 8.4 mg. of pteroylhepta- 

 glutamic acid and about 0.3 mg. of PGA.'^' The therapeutic efficacy of 

 thymine in daily doses of 15 g. has been reported in four cases of sprue, 

 although the residts were less striking than those obtained with PGA.'^- 



PGA may be regarded as almost universally effective in the treatment 

 of the megaloblastic anemia of sprue and idiopathic steatorrhea, although 

 exceptions to this general rule have been reported. Jones et alP^ include 

 in a series of cases responding to vitamin B12 one patient with sprue and 

 megaloblastic anemia who had been receiving PGA, and Girdwood^^^ men- 

 tions cases of idiopathic megaloblastic anemia which became refractory to 

 PGA and developed manifestations of sprue in spite of its continued ad- 

 ministration. It has been common experience that the dramatic curative 

 effects of PGA in the sj^ndrome of endemic sprue are rarely observed in the 

 sporadic form of the disease, idiopathic steatorrhea. In the latter group 

 megaloblastic anemia is less common and, when present, generally less 

 severe than in endemic sprue. Furthermore, since there is evidence of asso- 

 ciated vitamin Bio deficiency in many cases of both endemic and sporadic 

 sprue, it is to be expected that relapse may occur after long-continued 

 administration of PGA, just as is true of addisonian pernicious anemia. 



(). Megaloblastic Anemias Believed to I^e Due Primarily 

 TO Lack of Vitamin B12 



This group of conditions includes certain nutritional anemias as well as 

 pernicious anemia, and megaloblastic anemias associated with fish tape- 

 's' W. J. Darl)y and K. Jones, Proc. Soc. ExplL Biol. Med. 60, 259 (1945). 

 »8« C. V. Moore, O. S. Jiicrl)auni, A. 1). Wclcli, and L. I). Wrifihl, ./. Lab. Clin. .Med. 



30, 1056 (1945). 

 189 -p J) Spies, G. G. Lopez, J. A. Menendez, V. Minnich, and M. B. Koc-h, Southern 



Med. J. 39, 30 (1946). 

 '»» W. J. Darby, E. Jones, and H. C. Johnson, Scierice 103, 108 (1946). 

 '" R. M. Suarez, A. D. Welch, R. W. Heinle, R. M. Suarez, Jr., and K. M. Nelson, 



/. Lab. Clin. Med. 31, 1294 (1946). 

 192 'Y J) Spies, W. H. Frommeyer, G. G. Lopez, R. L. Toca, and G. Gwinner, Laiiecl 



I, 883 (1946). 

 '" E. Jones, W. J. Darby, and J. R. Totter, Blood 4, 827 (1949). 



