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. 1967 Sep;20(5):699–705. doi: 10.1136/jcp.20.5.699

Incidence and pathogenesis of megaloblastic erythropoiesis in multiple myeloma

A V Hoffbrand 1,2,3,1, J R Hobbs 1,2,3, S Kremenchuzky 1,2,3, D L Mollin 1,2,3
PMCID: PMC473554  PMID: 5602978

Abstract

Intermediate megaloblastic changes occurred in six (19%) of 32 patients with multiple myeloma and trivial megaloblastic changes in a further ten (31%). Folate deficiency was the predominant cause of these changes and in at least two patients was sufficiently severe to contribute to anaemia. Folate deficiency appeared to be due to exćess folate utilization by the tumour and was related to the amount of paraprotein produced daily.

Five of the 32 patients had subnormal serum B12 levels. Reduction in the serum B12 level was related to the reduction in the normal circulating immunoglobulins and occurred despite normal B12 absorption. Possible explanations for this finding are discussed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDERSON B. B. INVESTIGATIONS INTO THE EUGLENA METHOD FOR THE ASSAY OF THE VITAMIN B12 IN SERUM. J Clin Pathol. 1964 Jan;17:14–26. doi: 10.1136/jcp.17.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BICHEL J. MEGALOBLASTIC ANAEMIA AND MYXOEDEMA IN A PATIENT SUFFERING FROM MYELOMA, OBSERVED FOR A PERIOD OF 16 YEARS. Acta Med Scand. 1964 Aug;176:165–168. doi: 10.1111/j.0954-6820.1964.tb00922.x. [DOI] [PubMed] [Google Scholar]
  3. DE VRIES J. A., FABER J. G., MANDEMA E., NIEWEG H. O. Gehalte aan vitamine B12 in het serum van lijders aan multipel myeloom. Ned Tijdschr Geneeskd. 1956 Dec 1;100(48):3588–3589. [PubMed] [Google Scholar]
  4. DELLER D. J., WITTS L. J. Changes in the blood after partial gastrectomy with special reference to vitamin B12. I. Serum vitamin B12, haemoglobin, serum iron, and bone marrow. Q J Med. 1962 Jan;31:71–88. [PubMed] [Google Scholar]
  5. DRIVSHOLM A. TURNOVER RATE OF PARAPROTEINS IN MYELOMATOSIS. STUDIES ON THE TURNOVER RATE OF SERUM PARAPROTEINS AFTER LABELLING IN VIVO, WITH SPECIAL REFERENCE TO REPEATED TURNOVER-RATE DETERMINATIONS. Acta Med Scand. 1964 Sep;176:257–267. [PubMed] [Google Scholar]
  6. Dacie J. V., White J. C. Erythropoiesis with Particular Reference to its Study by Biopsy of Human Bone Marrow: A Review. J Clin Pathol. 1949 Feb;2(1):1–32. doi: 10.1136/jcp.2.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. FORSHAW J. Megaloblastic erythropoiesis in multiple myeloma. Br Med J. 1963 Jul 13;2(5349):101–102. doi: 10.1136/bmj.2.5349.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. GABUZDA T. G. The turnover and distribution of I-131-labeled myeloma and macroglobulin proteins. J Lab Clin Med. 1962 Jan;59:65–80. [PubMed] [Google Scholar]
  9. GIRDWOOD R. H. Folic-acid-excretion studies in the investigation of malignant disease. Br Med J. 1953 Oct 3;2(4839):741–745. doi: 10.1136/bmj.2.4839.741. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hobbs J. R. A staining method for proteins and dextrans on cellulose acetate. Nature. 1965 Jul 17;207(994):292–293. doi: 10.1038/207292b0. [DOI] [PubMed] [Google Scholar]
  11. Hobbs J. R., Slot G. M., Campbell C. H., Clein G. P., Scott J. T., Crowther D., Swan H. T. Six cases of gamma-D myelomatosis. Lancet. 1966 Sep 17;2(7464):614–618. doi: 10.1016/s0140-6736(66)91927-1. [DOI] [PubMed] [Google Scholar]
  12. Hoffbrand A. V., Newcombe F. A., Mollin D. L. Method of assay of red cell folate activity and the value of the assay as a test for folate deficiency. J Clin Pathol. 1966 Jan;19(1):17–28. doi: 10.1136/jcp.19.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. KLAYMAN M. I., BRANDBORG L. Clinical application of cobalt 60-labeled vitamin B12 urine test. N Engl J Med. 1955 Nov 10;253(19):808–812. doi: 10.1056/NEJM195511102531903. [DOI] [PubMed] [Google Scholar]
  14. LARSSON S. O. Myeloma and pernicious anaemia. Acta Med Scand. 1962 Aug;172:195–205. doi: 10.1111/j.0954-6820.1962.tb07143.x. [DOI] [PubMed] [Google Scholar]
  15. LEE F. I., JENKINS G. C., HUGHES D. T., KAZANTZIS G. PERNICIOUS ANAEMIA, MYXOEDEMA, AND HYPOGAMMAGLOBULINAEMIA--A FAMILY STUDY. Br Med J. 1964 Mar 7;1(5383):598–602. doi: 10.1136/bmj.1.5383.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lampkin B. C., Shore N. A., Chadwick D. Megaloblastic anemia of infancy secondary to maternal pernicious anemia. N Engl J Med. 1966 May 26;274(21):1168–1171. doi: 10.1056/NEJM196605262742103. [DOI] [PubMed] [Google Scholar]
  17. MEYER L. M., BERTCHER R. W., CRONKITE E. P., SUAREZ R. M., MILLER I. F., MULZAC C. W., OLIVARRETA S. T. Co60 Vitamin B12 binding capacity of serum in persons with hematologic disorders, various medical diseases and neoplasms. Acta Med Scand. 1961 May;169:557–575. doi: 10.1111/j.0954-6820.1961.tb07866.x. [DOI] [PubMed] [Google Scholar]
  18. MOLLIN D. L., ROSS G. I. M. The vitamin B12 concentrations of serum and urine of normals and of patients with megaloblastic anaemias and other diseases. J Clin Pathol. 1952 May;5(2):129–139. doi: 10.1136/jcp.5.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. NATHANS D., FAHEY J. L., POTTER M. The formation of myeloma protein by a mouse plasma cell tumor. J Exp Med. 1958 Jul 1;108(1):121–130. doi: 10.1084/jem.108.1.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. REISNER E. H., Jr The nature and significance of megaloblastic blood formation. Blood. 1958 Apr;13(4):313–338. [PubMed] [Google Scholar]
  21. SANDKUHLER S. Das heutige Bild des Plasmozytoms. Dtsch Med Wochenschr. 1951 Feb 9;76(6):168–171. doi: 10.1055/s-0028-1116612. [DOI] [PubMed] [Google Scholar]
  22. SCHILLING R. F. Intrinsic factor studies II. The effect of gastric juice on the urinary excretion of radioactivity after the oral administration of radioactive vitamin B12. J Lab Clin Med. 1953 Dec;42(6):860–866. [PubMed] [Google Scholar]
  23. SWENDSEID M. E., SWANSON A. L., MEYERS M. C., BETHELL F. H. The nutritional status of folic acid in persons with leukemia and its possible relation to effects of aminopterin therapy. Blood. 1952 Mar;7(3):307–310. [PubMed] [Google Scholar]
  24. VAN DOMMELENC, OLIE R. J., SLAGBOOM G. B12 LACK ("PERNICIOUS ANAEMIA"), POSSIBLY CAUSED BY "PARASITIZATION" (CONSUMPTION BY A NEOPLASM), IN A CASE OF WALDENSTROEM'S MACROGLOBULINAEMIA. Acta Med Scand. 1964 Nov;176:611–618. [PubMed] [Google Scholar]
  25. WATERS A. H., MOLLIN D. L. Studies on the folic acid activity of human serum. J Clin Pathol. 1961 Jul;14:335–344. doi: 10.1136/jcp.14.4.335. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. WOKES F., BADENOCH J., SINCLAIR H. M. Human dietary deficiency of vitamin B12. Am J Clin Nutr. 1955 Sep-Oct;3(5):375–382. doi: 10.1093/ajcn/3.5.375. [DOI] [PubMed] [Google Scholar]

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