Oral Treatment of Pernicious Anaemia

Abstract

IT will not surprise many workers in the B₁₂ field to read that Dr. Heinivaara and Dr. Palva have obtained a remission over a period of 50 days in one case of pernicious anaemia, which was receiving a daily dosage of 60 µg of crystalline B₁₂ (see above). Indeed, in our original work¹ we chose this dosage because we knew that, being in the sub-optimal range, it should be sufficient to prevent deterioration during the period of test, and thus be ethically justifiable. To draw firm deductions about the significance of glutamic acid additives, however, from a comparison between the blood responses in two selected cases is too ingenuous. The important finding, of course, during this initial period of treatment on sub-optimal dosage is not the haematological response as assessed by haemoglobin (Hb) or packed cell volume (P.C.V.) readings over 50 days (which vary greatly from patient to patient), but the reticulocyte response, obtained from the same patient, on one form of therapy compared with that on another. This test—the double reticulocyte response test—is not our test as Heinivaara and Palva infer. It was originally described in 1935 by Minot and Castle², and is still regarded as the most reliable short-term method for the comparison of the therapeutic effect of two haematinics of unknown potency³.