Advertisement

Scurvy and anaemia

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      The clinical and haematologic findings in seven patients with scurvy are presented. Although all had overt scurvy, two were not anaemic. Four had hypochromic normoblastic erythropoiesis and one had a megaloblastic anaemia subsequently shown to be Addisonian,
      Complete haematologic remission was obtained with ascorbic acid in two patients. In two, the response to folic acid appeared to be insignificant and the complete response was attributable to ascorbic acid only. No haematologic change was produced in the patient with megaloblastic anaemia.
      In two patients the simultaneous occurrence of both scurvy and deficiency of vitamin B12 did not result in a megaloblastic anaemia.
      Therapy with ascorbic acid resulted in reduction of the urinary excretion of folic acid-like activity, with no significant changes in the excretion of citrovorum factor.
      The role of ascorbic acid in erythropoiesis is discussed and a hypothesis presented to explain the therapeutic responses to this vitamin of megaloblastic anaemias in scurvy reported by others.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cutforth R.H.
        Adult scurvy.
        Lancet. 1958; 1: 454
        • Dewhurst K.
        A case of scurvy simulating a gastric neoplasm.
        Brit. M. J. 1954; 2: 1148
        • Leitner Z.A.
        • Church I.C.
        Nutritional studies in a mental hospital.
        Lancet. 1956; 1: 565
        • Riches H.R.C.
        Scurvy.
        Brit. M. J. 1954; 2: 286
        • Rozner W.
        • Lloyd J.
        Haemorrhagic pleural effusion as a manifestation of scurvy.
        Lancet. 1958; 2: 393
        • Lind J.
        A Treatise of the Scurvy.
        Edinburgh University Press, Edinburgh1953
        • Biggs R.
        • MacFarlane R.G.
        Estimation of prothrombin in dicoumarin therapy.
        J. Clin. Path. 1949; 2: 33
        • Biggs R.
        • Douglas A.S.
        The thromboplastin generation test.
        J. Clin. Path. 1953; 6: 23
        • King E.J.
        • Wooton I.D.P.
        Micro-Analysis in Medical Biochemistry.
        in: 3rd ed. J. & A. Churchill, London1956: 57
        • Meynell M.J.
        • Cox E.V.
        • Cooke W.T.
        • Gaddie R.
        Serum-cyanocobalamin level in chronic intestinal disorders.
        Lancet. 1957; 1: 901
        • Ramsay W.N.M.
        The determination of iron in blood plasma or serum.
        Clin. Chim. Acta. 1957; 2: 214
        • Mandel E.E.
        • Gorsuch T.L.
        • Cooper G.E.
        Seromucoid in hepatobiliary disease.
        Clin. Chem. 1955; 1: 221
        • Cooke W.T.
        • Fowler D.
        • Cox E.V.
        • Gaddie R.
        • Meynell M.J.
        Seromucoids in regional ileitis and ulcerative colitis.
        Gastroenterology. 1958; 34: 910
        • Teply L.J.
        • Elvehjem C.A.
        The titrimetric determination of “Lacto-bacillus casei factor” and “folic acid”.
        J. Biol. Chem. 1945; 157: 303
        • Sauberlick H.E.
        • Bauman C.A.
        A factor required for the growth of leuconostoc citrovorum.
        J. Biol. Chem. 1948; 176: 165
        • Swendseid M.E.
        • Bethell F.H.
        • Ackermann W.W.
        The intracellular distribution of vitamin B12 and folinic acid in mouse liver.
        J. Biol. Chem. 1951; 190: 791
        • Cox E.V.
        • Gaddie R.
        • Matthews D.
        • Cooke W.T.
        • Meynell M.J.
        An inter-relationship between ascorbic acid and cyanocobalamin.
        Clin. Sc. 1958; 17: 681
      1. Cox, E. V., Meynell, M. J., Cooke, W. T. and Gaddie, R. Unpublished observations.

        • Cox E.V.
        • Meynell M.J.
        • Cooke W.T.
        • Gaddie R.
        The folic acid excretion test in the steatorrhoea syndrome.
        Gastroenterology. 1958; 35: 390
        • Crandon J.H.
        • Lund C.C.
        • Dill D.B.
        Experimental human scurvy.
        New England J. Med. 1940; 223: 353
        • McMillan R.B.
        • Inglis J.C.
        Scurvy; a survey of 53 cases.
        Brit. M. J. 1944; 2: 233
        • Vilter R.W.
        • Woolford R.M.
        • Spies T.D.
        Severe scurvy, a clinical and haematologic study.
        J. Lab. & Clin. Med. 1946; 31: 609
        • Ralli E.P.
        • Sherry S.
        Adult scurvy and the metabolism of vitamin C.
        Medicine. 1941; 20: 251
        • Ungley C.C.
        Some deficiencies of nutrition and their relation to disease.
        Lancet. 1938; 1: 875
        • Ungley C.C.
        Some deficiencies of nutrition and their relation to disease.
        Lancet. 1938; 1: 925
        • Boscott R.J.
        • Cooke W.T.
        Ascorbic acid requirements and urinary excretion of p-hydroxyphenylacetic acid in steatorrhoea and macrocytic anaemia.
        Quart. J. Med. 1954; 23: 307
        • Mohr W.
        Bericht über Vitamin-C-stoffwechsel-untersuchungen and pathologisch-anatomische Dünndarmbefunde bei Sprue.
        Deutsche Ztschr. Verdauungskr. 1939; 2: 142
        • Cox E.V.
        The megaloblastic anaemias.
        in: 3rd ed. M.D. Thesis. Durham University, 1958
        • Girdwood R.H.
        A folic acid excretion test in the investigation of intestinal absorption.
        Lancet. 1953; 2: 53
        • Alt H.L.
        • Chinn H.
        • Farmer C.J.
        The blood plasma ascorbic acid in patients with achlorhydria.
        Am. J. M. Sc. 1939; 197: 229
        • Wallerstein R.O.
        • Harris J.W.
        • Gabuzda Jr., G.J.
        Ascorbic acid deficiency in pernicious anaemia.
        Am. J. Med. 1953; 14: 532
        • Mueller J.F.
        • Will J.J.
        Inter-relationship of folic acid, vitamin B12 and ascorbic acid in patients with megaloblastic anaemia.
        Am. J. Clin. Nutrition. 1955; 3: 30
        • Stefanini M.
        • Dameshek W.
        The Hemorrhagic Disorders.
        Grune & Stratton, Inc, New York1955
        • Sturgis C.C.
        Haematology.
        Blackwell Scientific Publications, Oxford1955
        • Wintrobe M.M.
        Clinical Haematology.
        3rd ed. Kimplin, London1956
        • Cetingil A.I.
        • Ulutin O.N.
        • Karaca M.
        A platelet defect in a case of scurvy.
        Brit. J. Haemat. 1958; 4: 350
        • Robertson W.V.
        • Hinds H.
        Polysaccharide formation in repair tissue during ascorbic acid deficiency.
        J. Biol. Chem. 1956; 221: 791
        • Brown A.
        Megaloblastic anaemia associated with adult scurvy. Report of a case which responded to synthetic ascorbic acid.
        Brit. J. Haemat. 1955; 1: 345
        • Bronte-Stewart B.
        The anaemia of adult scurvy.
        Quart. J. Med. 1953; 22: 309
        • Medical Research Council of Great Britain (Vitamin-C Sub-Committee)
        Lancet. 1948; 1: 853
        • Brown A.
        The anaemia of scurvy.
        Glasgow M. J. 1951; 32: 95
        • Piranni C.L.
        Review; relation of vitamin C to adrenocortical function and stress phenomena.
        Metabolism. 1952; 1: 197
        • Zuelzer W.W.
        • Hutaff L.
        • Apt L.
        Relationship of anaemia and scurvy.
        Am. J. Dis. Child. 1949; 77: 128
        • McIntyre P.A.
        • Sachs M.V.
        • Krevans J.R.
        • Conley C.C.
        Pathogenesis and treatment of macrocytic anaemia.
        Arch. Int. Med. 1956; 98: 541
        • Badenoch J.
        • Evans J.R.
        • Richards W.C.D.
        • Witts L.J.
        Megaloblastic anaemia following partial gastrectomy and gastroenterostomy.
        Brit. J. Haemat. 1955; 1: 339
        • Proehl E.C.
        • May C.D.
        Experimental nutritional megaloblastic anaemia and scurvy in the monkey. III. Protophorphyrin, coproporphyrin, urobilinogen and iron in blood and excreta.
        Blood. 1952; 7: 671
        • Nichol C.A.
        • Welch A.D.
        Synthesis of citrovorum factor from folic acid by liver slices; augmentation by ascorbic acid.
        in: 2nd ed. Proc. Soc. Exper. Biol. & Med.74. 1950: 52
        • Welch A.D.
        • Nichol C.A.
        • Anker R.M.
        • Boehne J.W.
        The effect of ascorbic acid on the urinary excretion of citrovorum factor derived from folic acid.
        J. Pharmacol. & Exper. Therap. 1951; 103: 403
        • Broquist H.P.
        • Stokstad E.L.R.
        • Jukes T.H.
        Biochemical studies with the “Citrovorum Factor”.
        J. Lab. & Clin. Med. 1951; 38: 95
        • Gabuzda Jr., G.J.
        • Phillips G.B.
        • Schilling R.F.
        • Davidson C.S.
        Metabolism of pteroyl-glutamic acid and citrovorum factor in human scurvy.
        J. Clin. Invest. 1951; 30: 639
        • Doctor V.M.
        • Welch B.E.
        • Perrett R.W.
        • Brown C.L.
        • Gabay S.
        • Couch J.R.
        Metabolic inter-relationship between folic acid, vitamin B12 and the citrovorum factor.
        in: 2nd ed. Proc. Soc. Exper. Biol. & Med.84. 1953: 29
        • Doctor V.M.
        • Trunnell J.B.
        Effect of sex hormones on conversion of folic acid to citrovorum factor by rat.
        in: 2nd ed. Proc. Soc. Exper. Biol. & Med.90. 1955: 251
        • May C.D.
        • Hamilton A.
        • Stewart C.T.
        Experimental megaloblastic anaemia and scurvy in the monkey. V. Nature of the relation of ascorbic acid deficiency to the metabolism of folic acid compounds.
        J. Nutrition. 1953; 49: 121
        • Silverman M.
        • Ebaugh Jr., F.E.
        • Gardiner R.C.
        The nature of labile citrovorum factor in human urine.
        J. Biol. Chem. 1956; 223: 259
        • Cox E.V.
        • Meynell M.J.
        • Cooke W.T.
        • Gaddie R.
        Folic acid and cyanocobalamin in pernicious anaemia.
        Clin. Sc. 1958; 17: 693