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Anemia of Primary Hyperparathyroidism-Reply

Lawrence E. Mallette, MD, PhD
Arch Intern Med. 1977;137(12):1744. doi:10.1001/archinte.1977.03630240074035.
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In Reply.—  If the preliminary observations of Better et al and of Zingraff et al are substantiated, it will mark another small increase in our ability to improve the well-being of patients with chronic renal failure. It will add still another reason for aggressive medical control of hyperparathyroidism in uremia and perhaps another indication for surgical intervention after medical control has failed.The nature of the marrow-space fibrosis in intense hyperparathyroidism remains obscure. Is the fibrosis actually within the marrow space, or is it contained within the bone cell envelope, thus encroaching on the marrow space from without? What are the cells which proliferate and what stimulates their growth? The observation of regression of the fibrosis with 1α-hydroxy-D3 treatment provides a tantalizing clue. We remain undecided whether this patchy loss of marrow space should be regarded as a significant factor in producing anemia, especially in the absence of the


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