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Pernicious Anemia

  • Mario García-Carrasco
  • Mario Jiménez-Hernández
  • Claudia Mendoza-Pinto
  • Alejandro Ruiz-Argüelles
  • Salvador Fuentes-Alexandro

Abstract

Pernicious anemia (PA) is the most common manifestation of vitamin B12 deficiency, in which an autoimmune pathogenesis is supported by (a) the presence of mononuclear-cell infiltration into gastric mucosa with loss of parietal cells, (b) autoantibodies to parietal cells and intrinsic factor, (c) autoreactive T cells, (d) regeneration of parietal cells after therapy with corticosteroids or immunosuppressive drugs, (e) familial predisposition and (f) association with other autoimmune diseases. The progression of the chronic atrophic gastritis to gastric atrophy and clinical anemia is likely to span 20 to 30 years. The presence of serum antibodies to gastric parietal-cells predicts autoimmune gastritis. Immune suppression with corticosteroids or azathioprine appears to be the best treatment in early stages of the disease.

Keywords

Pernicious anemia vitamin B12 deficiency type A gastritis 

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References

  1. 1.
    Kumar V. Pernicious anemia. MLO Med Lab Obs 2007 Feb;39(2):28, 30–1.Google Scholar
  2. 2.
    Andres E, Federici L, Affenberger S, Vidal-Alaball J, Loukili NH, Zimmer J, Kaltenbach G. B12 deficiency: A look beyond pernicious anemia. J Fam Pract 2007 Jul; 56(7): 537–42.Google Scholar
  3. 3.
    Toh BH, Van Dreil IR, Gleeson PA. Pernicious anemia. N Engl J Med 1997;337:1441–48.CrossRefPubMedGoogle Scholar
  4. 4.
    Carmel, R. Prevalence of undiagnosed pernicious anemia in the elderly. Arch Intern Med 1996;156:1097.CrossRefPubMedGoogle Scholar
  5. 5.
    Wun Chan JC, Yu liu HS, Sang Kho BC, Yin Sim JP, Hang Lau TK, Luk YW, Chu RW, Fung Cheung FM, Tat Choi FP, Kwan Ma ES. Pernicious anemia in Chinese. Medicine 2006; 85:129–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Castle WB. Development of knowledge concerning the gastritis intrinsic factor and its relation to pernicious anemia. N Eng J Med 1953;249:603–14.Google Scholar
  7. 7.
    Taylor KB. Inhibition of intrinsic factor by pernicious anemia sera. Lancet 1959;2:1347–52.Google Scholar
  8. 8.
    Junca J, de Soria PL, Granada ML, Flores A, Márquez E. Detection of early abnormalities in gastric function in first-degree relatives of patients with pernicious anemia. Eur J Haematol 2006;77:518–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Ungar B, Matthews JD, Tait BD, Cowling DC: HLA-DR patterns in pernicious anaemia. Br Med J 1981;282:768.CrossRefGoogle Scholar
  10. 10.
    Ban-Hock, van Driel, Ian R, Gleeson, Paul A. Mechanisms of Disease: Pernicious Anemia. N Engl J Med 1997 Nov 13; 337(20):1441–8.Google Scholar
  11. 11.
    Ruiz-Argüelles A, Jímenez-Brito G, Reyes-Izquierdo P, Pérez-Romano B, Sánchez-Sosa S. Apoptosis of melanocytes in vitiligo results from antibody penetration. J Autoimmun; 2007;29:281–6.Google Scholar
  12. 12.
    McHuhgs RS. Autoimmune gastritis is a well-defined autoimmune disease model for the study of the CD4+ CD25+ T cell-mediated suppression. Curr Top Microbiol Immunol 2005;293:153–77.CrossRefGoogle Scholar
  13. 13.
    McIntyre OR, Sullivan LW, Jeffries GH, Silver RH. Pernicious anemia in childhood. N Eng J Med 1965;272:981–86.Google Scholar
  14. 14.
    Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency. Blood 1990;76:871–81.PubMedGoogle Scholar
  15. 15.
    Hsing AW, Hansson L-E, McLaughllin JK, et al. Pernicious anemia and subsequent cancer: A population-based cohort study. Cancer 1993;71:745–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Kaye MD, Whorweel PJ, Wright R. Gastric mucosal lymphocyte subpopulations in pernicious anemia and in normal stomach. Clin Immunol Immunopathol 1983; 28: 431–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Anne-Mette Hvas et al. Diagnosis and treatment of vitamin B12 deficiency: An update. Haematologica 2006;91:1506–12.Google Scholar
  18. 18.
    Goringe A, Ellis R, McDowell I, Vidal-Alaball J, Jenkins C, Butler C, et al. The limited value of methylmalonic acid, homocysteine and holotranscobalamin in the diagnosis of early B12 deficiency. Haematologica 2006;91:231–4.PubMedGoogle Scholar
  19. 19.
    Provan D, Weatherall D. Red cells II: Acquired anaemias and polycythaemia. Lancet 2000;355:1260–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Ballinger A. Gastroenterology and Anaemia. Medicine 2007;35(3):142–6.CrossRefGoogle Scholar
  21. 21.
    Butler CC, Vidal-Alaball J, Cannings-John R, McCaddon A, Hood K, Papaioannou A, Mcdowell I, Goringe A. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: A systematic review of randomized controlled trials. Fam Pract 2006;23(3):279–85.CrossRefPubMedGoogle Scholar
  22. 22.
    Bolaman Z, Kadikoylu G, Yukselen V, Yavasoglu I, Barutca S, Senturk T. Oral versus intramuscular cobalamin treatment in megaloblastic anemia: A single-center, prospective, randomized, open-label study. Clin Ther 2003;25:3124–34.CrossRefPubMedGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Mario García-Carrasco
    • 1
    • 2
  • Mario Jiménez-Hernández
    • 1
    • 2
  • Claudia Mendoza-Pinto
    • 1
  • Alejandro Ruiz-Argüelles
    • 3
  • Salvador Fuentes-Alexandro
    • 4
  1. 1.Systemic Autoimmune Diseases Research Unit, HGR #36, CMN Manuel Ávila Camacho, IMSSPueblaMéxico
  2. 2.Rheumatology DepartmentBenemerita Universidad Autonoma de Puebla, School of MedicinePueblaMéxico
  3. 3.Laboratorios Clínicos de PueblaPueblaMéxico
  4. 4.Internal Medicine CMN siglo XXI, Instituto Mexicano del Seguro SocialMéxico

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