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Overtreating the Deficiency Anemias

William H. Crosby, MD
Arch Intern Med. 1986;146(4):779. doi:10.1001/archinte.1986.00360160227028.
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One great pleasure of hematologic practice is the predictable response to specific therapy of a patient with deficiency anemia. The deficiency anemias, caused by lack of cobalamin, folic acid, or iron, are curable with an optimal response to small doses of the missing nutrient and minimal risk of side effects. Not only that, but before the anemia is corrected the patient begins to feel better. With such information in the public domain, why is overtreatment of deficiency anemia the standard practice?

COBALAMIN DEFICIENCY  Pernicious anemia (PA) and other cobalamin deficiencies are always treated with large, frequent intramuscular injections of cyanocobalamin: 1,000 μg per injection until ten or 20 injections have been given and, after that, one a month.1 When Minot and Murphy2 described their method of treating PA by feeding 240 g of liver per day, they achieved remissions in all patients. Such daily doses of liver contain


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