The concept of aplastic anemia was described for the first time by Ehrlich in 1888,
which was characterized by pancytopenia or a selective depression of red cells, white
cells, or platelets. Since then, various thrapeutic trials such as removal of possible
etiologic factors, the judicious use of transfusion, bone marrow stimulation with
corticosteroid and androgen, splenectomy and thymectomy in certain circumstances and
good supportive care, were attempted to treat aplastic anemia without response.
However, there are many reports improved with androgenic hormone, often given in
conjunction with a corticosteroid preparation.
As a general rule, pharmacologic doses of folic acid was known to be ineffective in
treating aplastic anemia. But Crosby et al. reported aplastic anemia successfully treated
with large doses of folic acid. First in Korea Chai et al. had presented one case in 1968.
This paper presents the second case of aplastic anemia satisfactory improved with large
amounts of folic acid which we experienced again recently.
A 39 year old male was admitted to the department of internal medicine, Yonsei
medical center on June 18, 1970, complaining of headache, dizziness and general
weakness of about 6 months' duration. He had been diagnosed as aplastic anemia,
which was confirmed by bone marrow studies, at another hospital 4 months before
admission to our department and treating with testosterone and prednisolone in addition
to intermittent transfusion of 10 pints of fresh whole blood for 4 months without any
effects. Past and family history were not contributory.
Physical findings on admission revealed no abnormal finding except pale face and
conjunctive and scattered petechiae. Peripheral blood findings showed RBC 2.52million/㎣,
Hb. 6 gm% , Hct. 19%, WBC 2,000/㎣ with neutrophiles 12% and lymphocytes 88%,
platelet count 10,000/㎣ and reticulocytes count 0.4%. The sternal bone marrow revealed
marked decrease of hemopoietic cells with increased fat cell and most of them were
mature lymphocytes, but the megakaryocytes were not identified.
Testosterone and prednisolone were discontinued after admission and large doses of
folic acid were tried. About 4 months after oral administration of folic acid, 150 ㎎ per
day, peripheral blood and bone marrow findings were begun to be improved and 13
months later revealed normal pattern.
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