Blood, 1960, Vol. 15, No. 5, pp. 724-740.
© 1960 American Society of Hematology, Inc.
Megaloblastic Anemia of Pregnancy: Characteristics of
Pure Megaloblastic Anemia and Megaloblastic
Anemia Associated with Iron Deficiency
MIGUEL LAYRISSE 1,
OSCAR AGUERO 1,
NORMA BLUMENFELD 1,
HENRY WALLIS 1,
IRIS DUGARTE 1, and
ADELINA OJEDA 1
1 Centro de Investigaciones del Banco Municipal de Sangre, Caracas, Venezuela,
and Maternidad Concepcion Palacios and Instituto de Investigaciones Medicas (Fundacion
Luis Roche).
Morphology of the peripheral blood and bone marrow, iron, folic acid
and vitamin B12 metabolism and estimation of erythrokinetics have been
made in 17 patients with megaloblastic anemia of pregnancy.
The peripheral blood showed the classic picture of megaloblastic anemia
of pregnancy previously reported. Nine cases exhibited megaloblastic series
in the marrow and 8 cases intermediate megaloblastic series.
Folic acid malabsorption was observed in 12 cases. The malabsorption was
still present after remission in 6 of 7 cases studied. Folic acid induced complete or partial remission in all the cases but one. In cases with partial remission iron deficiency anemia developed and responded adequately to
iron therapy.
The average of the serum level of vitamin B12 showed a diminution of
approximately 39 per cent below normal level. Normal pregnant women
belonging to the same social condition of the patients and well-to-do
pregnant women showed the same reduction.
The erythrokinetics demonstrated that megaloblastic hyperplasia and iron
turnover values do not correlate with the reticulocyte count. This indicates
that the marrow activity was ineffective in terms of red cell production. This
marrow dysfunction was associated with an increased rate of red cell destruction: approximately 4 times normal.
The clinical and laboratory data collected suggest the division of megaloblastic anemia cf pregnancy into two types: pure megaloblastic anemia of
pregancy, and megaloblastic anemia associated with iron deficiency. The
morphologic characteristics, the amount of hemosiderin contained in the
bone marrow, the reticulocyte count, plasma iron, T 
plasma iron clearance, plasma iron turnover, and response to treatment may permit one to
separate one type from another.
