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654 Part VI: The Erythrocyte Chapter 44: Anemia Resulting From Other Nutritional Deficiencies 655

In addition to folate deficiency, chronic alcoholics frequently 20. Lane M, Alfrey CP Jr: The anemia of human riboflavin deficiency. Blood 25:432–442,
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of megaloblastic anemia, reticulocytosis secondary to hemolysis or 25. Bay A, Keskin M, Hizli S, et al: Thiamine-responsive megaloblastic anemia syndrome.
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rather than oval and neutrophil hypersegmentation is not present. The 28. Zhao R, Goldman ID: Folate and thiamine transporters mediated by facilitative carriers
macrocytosis persists until the patient abstains from alcohol. Even then, (SLC19A1–3 and SLC46A1) and folate receptors. Mol Aspects Med 34(2–3):373–385,
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in view of the life span of erythrocytes. 103 29. Reuler JB, Broudy VC, Cooney TG: Adult scurvy. JAMA 253(6):805–807, 1985.
30. Hodges RE, Baker EM, Hood J, et al: Experimental scurvy in man. Am J Clin Nutr
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red cell precursors, and formation of vacuoles can be observed in in 31. Zalusky R, Herbert V: Megaloblastic anemia in scurvy with response to 50 microgm. of
vitro marrow cell cultures. 99,105 These changes disappear promptly when folic acid daily. N Engl J Med 265:1033–1038, 1961.
alcohol ingestion is discontinued. Vacuolization with a similar appear- 32. Stokes PL, Melikian V, Leeming RL, et al: Folate metabolism in scurvy. Am J Clin Nutr
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hyperosmolar coma, and individuals deficient in copper or riboflavin. 104 34. Clark NG, Sheard NF, Kelleher JF: Treatment of iron-deficiency anemia complicated by
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Two relatively uncommon hematologic complications of alcohol- 35. Wapnick AA, Lynch SR, Krawitz P, et al: Effects of iron overload on ascorbic acid
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