Effect on Pernicious Anemia of Massive Doses of Parenteral Liver Extract

Abstract

With the increased use of parenteral liver extract for both the treatment of the relapse of pernicious anemia and the maintenance of normal blood levels during remissions of the disease, the questions of dose and the intervals between doses have been shown to be of great importance. Castle 1 states: “The parenteral injection at appropriate intervals of material derived from an amount of animal liver equivalent to the weight of that organ in man will suffice to maintain a patient with pernicious anemia in health for at least a year.” The accepted dose for most patients with pernicious anemia to maintain the normal blood level is the material derived from 100 gm. of liver given at intervals of one to 3 weeks. 2 There is, however, in the literature the record of one case 3 maintaining a normal blood level for 120 days after massive doses of potent material; and there are 2 other suggestions 4 , 5 that for several months individuals might maintain normal levels if given massive injections of concentrated material.

We have tried to determine whether patients with pernicious anemia could store the potent substance if given in massive amounts over a short period of time, and use it as their needs required. If a patient with pernicious anemia requires the material from 400 gm. of liver (as parenteral extract) for remission from relapse, and then that from 100 gm. every 2 weeks for the maintenance of a normal blood level, that patient would require the material from 700 gm. of liver for maintenance through 14 weeks. It is conceivable, however, that if this were given in a short period of time, some of the antianemic substance might be broken down, and that part of it might be excreted whole.