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American Journal of Clinical Nutrition, Vol 18, 110-115, Copyright © 1966 by The American Society for Clinical Nutrition, Inc.

Anemia Due to Vitamin B12 Deficiency After Treatment with Folic Acid in Tropical Sprue

JULIO V. RIVERA M.D.1, F. RODRIGUEZ DE LA OBRA M.D.1, M. MARTÍNEZ MALDONADO M.D.1, and AIDA FERNÁNDEZ 1

1 From the Medical and Laboratory Services, Veterans Administration Hospital, San Juan, Puerto Rico and the Department of Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico

A patient with tropical sprue is described who, after an initial response to folic acid therapy, had a relapse of megaloblastic anemia while still receiving 5 mg. daily of the vitamin. The blood level of folic acid was normal whereas that of vitamin B12 was very low. Oral and parenteral folic acid therapy was without effect, the bone marrow retaining megaloblastic characteristics. Prompt response to the parenteral administration of 2 µg. of vitamin B12 daily was observed. It is postulated that because of impaired intestinal absorption vitamin B12 deficiency persisted despite treatment with folic acid and was the cause of the anemia. It is suggested that tropical sprue is best treated with both folic acid and vitamin B12.






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Copyright © 1966 by The American Society for Nutrition