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Correlation of Folate Deficiency with Alcoholism and Associated Macrocytosis, Anemia, and Liver Disease

Ann Intern Med. 1963;58(6):977-988. doi:10.7326/0003-4819-58-6-977
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Macrocytosis has been observed frequently in association with cirrhosis since 1884 (1). The concomitant presence of macrocytosis, anemia, and cirrhosis, usually in association with alcoholism, sometimes with a macronormoblastic or even a megaloblastic bone marrow, has been frequently noted in the medical literature (2-10).

In 1938, noting no correlation between macrocytosis and severity of liver damage, Bianco and Jolliffe (2) concluded: "In view of these findings we are inclined to regard the macrocytosis of the alcohol addict not as a manifestation of inability on the part of the liver to store a hematopoietic principle, but as an extrinsic deficiency of


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