Spivak J L
Arch Intern Med. 1982 Nov;142(12):2111-4.
In six patients, eight episodes of anemia associated with folic acid or vitamin B12 deficiency were unaccompanied by macrocytosis. Six of the eight episodes of anemia were complicated by illnesses of an inflammatory or infectious nature, two patients had iron deficiency, two appeared to have a thalassemia trait, and one had severe renal failure. In five of the eight episodes, erythropoiesis was not megaloblastic and there was insufficient anisocytosis or poikilocytosis to suggest an underlying vitamin deficiency state. Hypersegmented neutrophils were observed in all episodes, but a neutrophil lobe average of greater than 3.5 lobes per cell was observed only once, and in one patient, less than 5% of the circulating neutrophils were hypersegmented. Giant metamyelocytes, however, were present in the marrow in all of the episodes and provided an important clue to the presence of the vitamin deficiency state.
在6例患者中，8次与叶酸或维生素B12缺乏相关的贫血发作未伴有大细胞性贫血。8次贫血发作中有6次并发炎症性或感染性疾病，2例患者缺铁，2例似乎有地中海贫血特征，1例有严重肾衰竭。在8次发作中的5次，红细胞生成不是巨幼细胞性的，且异形红细胞增多症或红细胞大小不均一性不足以提示潜在的维生素缺乏状态。在所有发作中均观察到核分叶过多的中性粒细胞，但仅在1次观察中发现平均每个细胞的中性粒细胞叶数大于3.5叶，且在1例患者中，循环中性粒细胞中核分叶过多的比例不到5%。然而，在所有发作的骨髓中均存在巨大晚幼粒细胞，这为维生素缺乏状态的存在提供了重要线索。
