Scurvy megaloblastic anemia

The water-soluble vitamins comprise the B complex and vitamin C and function as enzyme cofactors. Fofic acid acts as a carrier of one-carbon units. Deficiency of a single vitamin of the B complex is rare, since poor diets are most often associated with multiple deficiency states. Nevertheless, specific syndromes are characteristic of deficiencies of individual vitamins, eg, beriberi (thiamin) cheilosis, glossitis, seborrhea (riboflavin) pellagra (niacin) peripheral neuritis (pyridoxine) megaloblastic anemia, methyhnalonic aciduria, and pernicious anemia (vitamin Bjj) and megaloblastic anemia (folic acid). Vitamin C deficiency leads to scurvy. 

The question of vitamin supplementation obviously requires an affirmative answer when one considers therapy for overt, specific deficiency syndromes such as scurvy, rickets, beriberi, pellagra, megaloblastic anemia, ariboflavinosis, and convulsions due to pyridoxine deficiency. In some syndromes, biochemical evidence of deficiency occurring before overt symptoms is accepted as indication for general preventive supplementation. For example, the hydroxyphenyluria of premature infants and decreased serum phosphate and citrate, are taken as indications for early... 

May et al. (1950a,b, 1951) originally considered that ascorbic acid was necessary for the conversion of pteroylglutamic acid to citrovorum factor. In monkeys fed on diets deficient both in ascorbic acid and folic acid, megaloblastic anemia developed. This could be relieved by ascorbic acid, by folic acid in large doses, or by small doses of citrovorum factor. Later May et al. (1953) reported that ascorbic acid was not required for the conversion of folic acid to citrovorum factor. The severe deficiency of folic acid compounds occurring in scorbutic monkeys was probably due to nonspecific factors operating in scurvy. 

The possible role of scurvy and infection in the causation of megaloblastic anemia is discussed on pages 188 and 198. 

Metabolism of folic acid (folacin)—Vitamin C is required for the conversion of the inactive form of the vitamin, folic acid (folacin), to its active form, folinic acid. When there is an insufficiency of vitamin C in the diet, the metabolism of folic acid (folacin) is impaired and the megaloblastic anemia that occurs in scurvy, and sometimes in infancy, may result... 

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