Anemias With Renal Transplantation

Abstract

To the Editor.— Pierce et al (219:1593, 1972) reported lymphomas as a complication of renal transplantation. They stated that in two of their three cases of reticulum cell sarcoma the earliest manifestation of the tumor was a macrocytic anemia which occurred in the presence of maintenance folic acid (PGA) therapy and which, in one case, responded to treatment with folinic acid. Dossetor et al, in 1964 1 described in one patient the presence of macrocytic anemia and megaloblastic marrow with normal serum levels of vitamin B 12 and folate but reduced red blood cell (RBC) folate levels, in the absence of tumor. They commented on the lack of information on azathioprine interfering with vitamin B 12 action. In 1965, Mowbray et al 2 reported four transplant patients treated with azathioprine, who developed macrocytic megaloblastic anemia. In one patient, an abnormal formiminoglutamic acid excretion after histidine load suggested interference with folic