Pernicious Anemia Research Articles

Laparoscopic total gastrectomy for multiple type І gastric neuroendocrine tumours: a case report

Background. The gastric neuroendocrine tumours (G-NETs), arising from neuroendocrine cells within the stomach. Type I lesions are associated with chronic atrophic gastritis (CAG). Multiple G-NETs are rare. Purpose – of our report is to describe a rare case of multiple Type-I G-NETs. Material and methods. During routine gastroscopy in a 44-year-old female with history of CAG and anaemia, multiple (15–20) polyps of size 2–9 mm were found. Multiple biopsies were obtained. Histopathological examination with haematoxylin and eosin staining described these lesions as undifferentiated cancer. Repeated gastroscopy was done. The three biggest polyps (5–9 mm) were removed by snare polypectomy. Repeated histopathological examination was specific for G-NET. The neoplasm presented Ki-67 proliferation index of < 3%; Cytokeratin 18, Chromogranin A, Synaptophysin, INSM1 were positive in neoplasm cells. Laparoscopic total gastrectomy was done. The operative time was 255 min, and the blood loss was 50 ml. Histopathological examination of a surgical specimen revealed multiple, Grade 1 G-NET (fig. 1–3). All lesions are limited to the mucosa and submucosa of the stomach, the longest size of the largest tumour lesion is 5 mm, what corresponds to pT1(m). No signs of lymphovascular or perineural invasion were found (L0 V0 Pn0). 18 regional lymph nodes were examined, no metastases were detected (0/18, pN0). Edges of resections of the esophagus and duodenum without signs of tumour growth (R0). Outside of tumours, there were signs of chronic inflammation of the stomach mucosa, with intestinal metaplasia and mixed glandular atrophy, there are also foci of nodular hyperplasia of neuroendocrine cells. Conclusion. We reported a rare case of multiple type-I G-NETs (pT1N0M0) with pernicious anaemia due to autoimmune CAG. Laparoscopic total gastrectomy is a method of choice in treatment of such patients.

When Euphoria Turns to Neuropathy: Vitamin B12 Deficiency Related to Nitrous Oxide

Background: Nitrous oxide is a widely abused inhalant known for its rapid onset of euphoric sensations. Chronic use, however, can result in functional vitamin B12 deficiency, causing megaloblastic anemia, peripheral neuropathy, and subacute combined degeneration (SCD) of the spinal cord. Case Presentation: This case report examines a 43-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) and chronic back pain, who presented with neurological symptoms secondary to chronic nitrous oxide use, subsequent B12 deficiency. The patient reported a one week history of lower extremity swelling, paresthesias, and vertigo. He admitted to daily nitrous oxide use for the past month. Neurological examination revealed ataxia, impaired proprioception, and a positive Romberg test. Laboratory studies showed macrocytic anemia and a severely decreased B12 level. MRI of the cervical spine revealed T2 hyperintensity in the dorsal columns, consistent with SCD. He was treated with intramuscular B12 and advised to discontinue nitrous oxide use. At a three-month follow-up, significant neurological improvement was noted, allowing him to return to work. Conclusion: Chronic nitrous oxide use can lead to functional B12 deficiency and subacute combined degeneration, a potentially reversible condition if treated early. Differential diagnoses include pernicious anemia, malabsorption syndromes, and other neurological disorders. Prompt diagnosis through serum B12, methylmalonic acid, homocysteine levels, and spinal imaging is essential to prevent permanent neurological damage. Nitrous oxide abuse is an emerging cause of B12 deficiency. Early recognition and intervention are essential for recovery. Healthcare providers should consider B12 deficiency in patients presenting with neurological symptoms and a history of nitrous oxide use.

Co-existence of ANCA–associated vasculitides with immune-mediated diseases: a single-center observational study

BackgroundAntineutrophil cytoplasmic antibody-associated vasculitides (AAV) is a group of systemic necrotizing small vessel autoimmune diseases, with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) being the two most common. The co-existence of AAV with different immune-mediated diseases (autoimmune disesases - AID) might affect the clinical presentation of the primary disease. The purpose of the study was to assess the co-existence of AAV with AID and to investigate whether it affects the characteristics and the course of AAV.MethodsA retrospective single-center study was performed to identify patients with a diagnosis of MPA or GPA and concomitant AID, and to investigate their clinical features and characteristics. The group consisted of consecutive unselected AAV patients treated at a large university-based hospital, since 1988 with follow-up until 2022.ResultsAmong 284 patients diagnosed either with GPA (232) or MPA (52), 40 (14,1%) had co-existing AIDs. The most frequent were: Hashimoto thyroiditis (16 cases), rheumatoid arthritis (8 cases), followed by psoriasis (6 cases), pernicious anemia (3 cases), and alopecia (3 cases). Patients with autoimmune comorbidities had a significantly longer time between the onset of symptoms and the diagnosis (26 vs. 11 months, p < 0.001). Laryngeal involvement (20.0% vs. 9.0%, p = 0,05), peripheral nervous system disorders (35.0% vs. 13.9%, p < 0.001), and neoplasms (20.0% vs. 8.6%, p = 0,044) were more common in patients with AID comorbidities, compared to subjects without AID. In contrast, renal involvement (45.0% vs. 70.9%, p = 0.001) and nodular lung lesions (27.5% vs. 47.5%, p = 0.044) were significantly less frequent in patients with co-morbidities. Following EUVAS criteria, patients with autoimmune co-morbidities had a generalized form of the disease without organ involvement (52.5% vs. 27.2%, p = 0.007), while the others had a higher percentage of generalized form with organ involvement (38.3% vs. 20.0%, p = 0.007).ConclusionsThe coexistence of AAV with different autoimmune diseases is not common, but it might affect the clinical course of the disease. Polyautoimmunity prolonged the time to diagnosis, but the AAV course seemed to be milder. Particular attention should be paid to the increased risk of cancer in these patients. It also seems reasonable that AAV patients should receive a serological screening to exclude the development of overlapping diseases.

Vitamin B12: prevention of human beings from lethal diseases and its food application.

Vitamin B12, a water-soluble essential micronutrient, plays a pivotal role in numerous physiological processes in the human body. This review meticulously examines the structural complexity and the diverse mechanisms through which vitamin B12 exerts its preventive effects against a spectrum of health conditions, including pernicious anaemia, neurological disorders, obesity, diabetes, dyslipidaemia and complications in foetal development. The selection of articles for this review was conducted through a systematic search across multiple scientific databases, including PubMed, Scopus and Web of Science. Criteria for inclusion encompassed relevance to the biochemical impact of vitamin B12 on health, peer-reviewed status and publication within the last decade. Exclusion criteria were non-English articles and studies lacking empirical evidence. This stringent selection process ensured a comprehensive analysis of vitamin B12's multifaceted impact on health, covering its structure, bioavailable forms and mechanisms of action. Clinical studies highlighting its therapeutic potential, applications in food fortification and other utilizations are also discussed, underscoring the nutrient's versatility. This synthesis aims to provide a clear understanding of the integral role of vitamin B12 in maintaining human health and its potential in clinical and nutritional applications. © 2024 The Author(s). Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Primary antibody deficiency, pernicious anaemia and gastric cancer: An intriguing triangular relationship

Primary antibody deficiency, pernicious anaemia and gastric cancer: An intriguing triangular relationship

Pernicious Anaemia as a Cause of Ischemic Hepatopathy

Pernicious Anaemia as a Cause of Ischemic Hepatopathy

Synchronous cancers of the stomach and esophagus in a patient with autoimmune gastritis and pernicious anemia: a case report and review of the literature.

Type-A gastritis/autoimmune gastritis (AIG) has gained renewed attention due to declining Helicobacter pylori infection rates and increasing eradication. AIG is associated with pernicious anemia (PA) and is prone to complicate various tumors, such as gastric cancer and neuroendocrine tumors. This report describes a case of AIG with PA in which gastric and esophageal cancers arose simultaneously. An 86-year-old woman had been diagnosed with PA and AIG 9 years earlier. As routine blood tests revealed high levels of carcinoembryonic antigen, she underwent esophagogastroduodenoscopy, which revealed a type 0-IIa lesion in the middle part of the stomach and a type 0-IIa + IIb lesion in the lower esophagus. Endoscopic submucosal dissection was performed on both lesions, since neither distant nor lymph node metastases were identified. Histological examination showed gastric tubular adenocarcinoma and esophageal squamous cell carcinoma. Immunohistology revealed that cells from neither cancer expressed gastrin, gastrin receptor, or p53. Whole-exome sequencing showed 8 gene mutations in the esophageal cancer and 6 mutations in 5 genes in the gastric cancer. The reason for the lack of p53 immunostaining was that TP53 was mutated in these cancers, although TP53 mutations differed. Thus, TP53 mutations may not be detected by immunostaining alone. When treating patients with AIG/PA, clinicians must be aware of the possibility of esophageal cancer coexisting with gastric cancer.

Excess Folic Acid and Vitamin B12 Deficiency: Clinical Implications?

In the 1940s to 1950s, high-dose folic acid supplements (>5 mg/d) were used clinically to reverse the megaloblastic anemia of vitamin B12 deficiency caused by pernicious anemia. However, this treatment strategy masked the underlying B12 deficiency and possibly exacerbated its neuropathological progression. The issue of masking and exacerbating B12 deficiency has recently been rekindled with the institution of folic acid fortification and the wide-spread use of folic acid supplements. The objectives of this review are to describe clinical and epidemiological evidence that excess folic acid exacerbates B12 deficiency, to summarize a hypothesis to explain this phenomenon, and to provide guidance for clinicians. Cognitive function test scores are lower and blood homocysteine and methylmalonic acid concentrations are higher in people with low B12 and elevated folate than in those with low B12 and nonelevated folate. High-dose folic acid supplementation in patients with pernicious anemia or epilepsy cause significant reductions in serum B12. It is hypothesized that high-dose folic acid supplements cause depletion of serum holotranscobalamin and thus exacerbate B12 deficiency. The evidence for excess folic acid exacerbating B12 deficiency is primarily correlative or from uncontrolled clinical observations, and the hypothesis to explain the phenomenon has not yet been tested. Nonetheless, the evidence is sufficiently compelling to warrant increased vigilance for identifying B12 deficiency in at risk individuals, including older adults and others with low B12 intake or conditions that are associated with B12 malabsorption, who also ingest excessive folic acid or are prescribed folic acid in high doses.

A Systematic Review of Symptoms of Pernicious Anemia.

Pernicious anemia (PA) is a type of macrocytic anemia caused by autoimmune gastritis. To facilitate timely diagnosis and treatment of PA there is a pressing need for improved understanding among Healthcare providers of the condition's symptoms and diagnostic criteria. This systematic review aims to extend existing clinical knowledge on the presentation of PA by determining which symptoms and clinical complications are reported in published adult case studies. Relevant studies were identified through electronic searches of PsycINFO, Embase, and MEDLINE, via OvidSP. During data extraction symptoms were categorized according to the International Classification of Diseases and were grouped based on frequency. Symptoms were documented for 103 adults with a diagnosis of PA; the most frequent symptoms were fatigue (55%), loss of sensation in limbs (32%), excessive weight loss (27%), and a sore tongue (23%). This review highlights the diverse symptomology of adults who are diagnosed with PA. Most symptoms documented in case studies are consistent with the core signs of B12 and folate deficiencies. Research is needed to identify if there are common clusters of PA symptoms that can be used as prompts for diagnostic testing in patients with suspected B12 deficiency.

The association between osimertinib and nutritional deficiency among patients with non-small cell lung cancer.

8031 Background: Osimertinib, a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), is the standard-of-care in EGFR mutation-positive non-small-cell lung cancer (NSCLC) in various settings. Osimertinib commonly causes gastrointestinal adverse effects thereby potentially leading to nutritional deficiencies. Therefore, we aim to evaluate the association between the use of osimertinib and nutritional deficiencies among patients with NSCLC. Methods: We performed a retrospective, propensity score matched study using the TriNetX database, a network comprising deidentified data across more than 120 participating healthcare institutions. We included patients with NSCLC who received either osimertinib or other EGFR-TKIs (afatinib, dacomitinib, erlotinib, gefitinib). The outcomes of interest included vitamin B deficiency, vitamin D deficiency, iron deficiency as well as associated anemia including vitamin B12 deficiency anemia, folate deficiency anemia, and iron deficiency anemia within 5 years of EGFR-TKI initiation. Results: We matched 4264 patients who received osimertinib to patients who received other EGFR-TKIs. In Cox proportional hazard analysis, osimertinib was associated with a 50% higher risk of vitamin B deficiency (Hazard ratio, 1.52 [95% CI: 1.07-2.16]) compared to other EGFR-TKIs. Consistent with this observation, osimertinib was associated with an increased risk of vitamin B12 deficiency anemia and a tendency towards folate deficiency anemia. We also noted a 2-fold higher risk of vitamin D and 5-fold higher risk of iron deficiency in the osimertinib cohort. Consistent with this observation, osimertinib was associated with an increased risk of iron deficiency anemia compared to other EGFR-TKIs. Conclusions: The use of osimertinib is associated with a higher risk of nutritional deficiencies and associated anemias compared to other EGFR-TKIs. One potential explanation is the extended duration of osimertinib therapy, driven by its potent anti-cancer effects. Therefore, it is advisable to consider screening for specific nutritional deficiencies in individuals receiving osimertinib therapy. [Table: see text]

Vitamin B12 Status and Supplementation in Plant-Based Diets.

Plant-based diets are increasingly popular worldwide. A well-planned plant-based diet lowers the risk of cardiovascular disease, type 2 diabetes and certain cancers. In contrast, a poorly planned plant-based diet increases the risk of certain micronutrient deficiencies, chiefly, vitamin B12 (B12). Because B12 is not present in plants or in unfortified plant-based foodstuffs, the safest way to prevent its deficiency in plant-based diets is to take an oral B12 supplement. Studies determining the dose and frequency of B12 to be taken by healthy individuals on a plant-based diet to support an adequate B12 status are scarce. Here, we summarize the natural sources, metabolic requirements, biomarker findings with and without supplementation with B12, and current recommendations to help prevent vitamin B12 deficiency in healthy individuals adhering or transitioning to plant-based diets. This review focuses on the prevention of vitamin B12 deficiency in healthy individuals adhering to plant-based diets. The information covered in this review does not apply to individuals suffering from autoimmune-based malabsorption of vitamin B12 resulting from pernicious anemia due to atrophic gastritis, other acquired causes of B12 malabsorption or to those with genetic disorders that impair vitamin B12 absorption, transport and utilization.

DESTRUCTION OF VITAMIN B12 DURING INTERACTION WITH ACTIVE OXYGEN SPECIES

One of the most attractive molecular systems in the world of chemistry and medicine is vitamin B12, which was originally discovered as a factor against deficiency (pernicious) anemia. Deficiency of this essential vitamin leads to a decrease in the number of red blood cells in the blood and a drop in hemoglobin levels. The article provides a brief overview of the processes leading to the destruction of vitamin B12 caused by hypoxia, the action hypochlorous acid, superoxide anion radical, hydrogen peroxide, hydroxyl radical, peroxynitrite. Under conditions of hypoxia, oxygen transport in the electron transport chain may be disrupted, resulting in the reduction of oxygen on ubiquinone to a superoxide radical under the action of electrons that have not reached cytochrome oxidase. Oxidative stress develops, during which oxygen-containing radicals are formed, which can cause irreversible changes in the vitamin and lead to loss of biological activity. Hydrogen peroxide formed as a result of step-by-step protonation of the formed superoxide-anion radicals can act as such oxidants. Hydrogen peroxide, in turn, is capable of reacting with metals of variable oxidation state to form a reactive hydroxyl radical, producing the Fenton reaction. In addition, hypochlorous acid formed by the enzyme myeloperoxidase in the presence of hydrogen peroxide and chloride anion, as well as peroxynitrite, an active oxidant obtained by reacting the superoxide–anion radical with nitrogen (II) oxide, can act as oxidants. The latter is produced in large quantities under hypoxia conditions due to an increase in the activity of endothelial nitric oxide synthetase. The publications devoted to the influence of various oxidants on the stability of vitamin B12 are considered. For citation: Erina A.A., Borodulin V.B., Dereven’kov I.A., Makarov S.V., Ischenko A.A. Destruction of vitamin B12 during interaction with active oxygen species. ChemChemTech [Izv. Vyssh. Uchebn. Zaved. Khim. Khim. Tekhnol.]. 2024. V. 67. N 7. P. 6-18. DOI: 10.6060/ivkkt.20246707.7043.

Oral vitamin B12 supplementation in pernicious anemia: a prospective cohort study

BackgroundThe absorption of vitamin B12 is hindered in pernicious anemia (PA) owing to intrinsic factor deficiency. Traditionally, intramuscular vitamin B12 injections were the standard treatment, bypassing the impaired absorption. Although there is potential for oral vitamin B12 supplementation through passive enteral absorption, it is not commonly prescribed in PA owing to limited studies assessing its efficacy. ObjectivesWe aimed to assess the efficacy of oral vitamin B12 supplementation in PA. MethodsWe enrolled participants diagnosed with incident vitamin B12 deficiency related to PA. The diagnosis of PA was based on the presence of classical immune gastritis and of anti-intrinsic factor and/or antiparietal cell antibodies. To evaluate the vitamin B12 status, we measured total plasma vitamin B12, plasma homocysteine, and plasma methylmalonic acid (pMMA) concentration and urinary methylmalonic acid–to–creatinine ratio. Participants were treated with oral cyanocobalamin at a dosage of 1000 μg/d throughout the study duration. Clinical and biological vitamin B12 deficiency related features were prospectively and systematically assessed over the 1-y study duration. ResultsWe included 26 patients with vitamin B12 deficiency revealing PA. Following 1 mo of oral vitamin B12 supplementation, 88.5% of patients were no longer deficient in vitamin B12, with significant improvement of plasma vitamin B12 [407 (297–485) compared with 148 (116–213) pmol/L; P < 0.0001], plasma homocysteine [13.5 (10.9–29.8) compared with 18.6 (13.7–46.8) μmol/L; P < 0.0001], and pMMA [0.24 (0.16–0.38) compared with 0.56 (0.28–1.09) pmol/L; P < 0.0001] concentrations than those at baseline. The enhancement of these biological parameters persisted throughout the 12-month follow-up, with no patients showing vitamin B12 deficiency by the end of the follow-up period. The median time to reverse initial vitamin B12 deficiency abnormalities ranged from 1 mo for hemolysis to 4 mo for mucosal symptoms. ConclusionsOral supplementation with 1000 μg/d of cyanocobalamin has been shown to improve vitamin B12 deficiency in PA.

Autoimmune conditions and gastric cancer risk in a population-based study in the United Kingdom

BackgroundAlthough overall incidence of gastric cancer is decreasing, incidence has been increasing among young people in some Western countries. This trend may stem from the increase in autoimmune conditions.MethodsA nested case-control study of gastric cancer in UK Clinical Practice Research Datalink. Up to ten cancer-free controls were matched to cases by age and sex. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for associations between analyzable autoimmune conditions (n = 34) and gastric cancer with Bonferroni correction. We evaluated associations between pernicious anaemia and other conditions. A meta-analysis of published prospective studies and ours was conducted.ResultsAmong 6586 cases (1156 cardia, 1104 non-cardia, and 4334 overlapping/unspecified tumours) and 65,687 controls, any autoimmune condition was associated with gastric cancer (OR = 1.10; 95% CI: 1.01–1.20). Individuals with pernicious anaemia had higher gastric cancer risk than those without (OR = 2.75; 2.19–3.44). Among controls, pernicious anaemia was associated with seven other conditions (OR range: 2.21–29.80). The pooled estimate for any autoimmune condition and gastric cancer was 1.17 (1.14–1.21; n = 47,126 cases).ConclusionAutoimmunity increases gastric cancer risk. Some autoimmune conditions may be indirectly associated with gastric cancer via pernicious anaemia. Pernicious anaemia could be considered for gastric cancer risk stratification and screening.

Causal inference between pernicious anemia and cancers: a bidirectional two-sample mendelian randomization analysis

BackgroundObservational study investigated the association between pernicious anemia (PA) and cancers. However, with the exception of gastric cancer, the results are mostly contradictory. The purpose of this study was to investigate the potential causal relationship between PA and cancers through bidirectional two-sample Mendelian randomized (MR) analysis.MethodsThe European sample FinnGen project provided the genetic summary data for PA and 20 site-specific cancers. This bidirectional two-sample MR design mainly used the inverse variance weighting (IVW) method to evaluate the causal relationship between PA and cancer risk. Benjamini-Hochberg correction was performed to reduce the bias caused by multiple tests.ResultsOur study shows that there was a causal relationship between PA and gastric cancer, prostate cancer, testicular cancer and malignant melanoma of skin, and there was a reverse causal relationship between prostate cancer or gastric cancer and PA (P < 0.05). After Benjamini-Hochberg correction test, there was still a causal correlation between PA and gastric or prostate cancer (P’ < 0.05), while there was only an implied causal association between PA and testicular cancer and malignant melanoma of skin (P’> 0.05). There was still a reverse causal relationship between gastric cancer and PA (P‘< 0.05), while prostate cancer shows an implied reverse causal relationship(P’> 0.05). In addition, MR-Egger and MR-PRESSO tests showed no significant horizontal pleiotropy.ConclusionsPA may be genetically associated with testicular cancer, prostate cancer, gastric cancer, and malignant melanoma of skin.

Roles of blood metabolites in mediating the relationship between vitiligo and autoimmune diseases: Evidence from a Mendelian randomization study

ObjectiveThis study employed Mendelian Randomization (MR) to investigate the causal relationship between genetic susceptibility to vitiligo and the risk of various autoimmune diseases, along with the mediating role of blood metabolites. MethodsWe performed two-sample MR analyses using aggregated genome-wide association studies (GWAS) data on 486 blood metabolites, vitiligo, and nine autoimmune diseases to investigate blood metabolites' causal effects on the susceptibility of vitiligo and the associations of vitiligo with nine autoimmune comorbidities. We also applied multivariable MR to unravel metabolites by which vitiligo influences the pathogenesis of autoimmune diseases. ResultsOur findings indicate that vitiligo amplified the risk of several autoimmune diseases, including rheumatoid arthritis (OR 1.17; 95 % CI 1.08–1.27), psoriasis (OR 1.10; 95 % CI 1.04–1.17), type 1 diabetes (OR 1.41; 95 % CI 1.23–1.63), pernicious anemia (OR 1.23; 95 % CI 1.12–1.36), autoimmune hypothyroidism (OR 1.19; 95 % CI 1.11–1.26), alopecia areata (OR 1.22; 95 % CI 1.10–1.35), and autoimmune Addison's disease (OR 1.22; 95 % CI 1.12–1.33). Additionally, our analysis identified correlations with vitiligo for 14 known (nine risk, five protective) and seven uncharacterized serum metabolites. After adjusting for genetically predicted levels of histidine and pyruvate, the associations between vitiligo and these diseases were attenuated. ConclusionsWe substantiated vitiligo's influence on susceptibility to seven autoimmune diseases and conducted a thorough investigation of serum metabolites correlated with vitiligo. Histidine and pyruvate are potential mediators of vitiligo associated with autoimmune diseases.By combining metabolomics with genomics, we provide new perspectives on the etiology of vitiligo and its immune comorbidities.

Establishing the Law of Parsimony in a Case of Restless Legs Syndrome

Restless legs syndrome (RLS) is a common movement disorder characterized by uncomfortable sensations in the lower limbs relieved by limb movements. Clinical studies have established a possible association between RLS and vitamin B12 deficiency but not a causal one. RLS has rarely been reported as an isolated neurological manifestation of vitamin B12 deficiency. In this case report, we described a 24-year-old young man with RLS who responded poorly to symptomatic therapy. The etiological evaluation suggested vitamin B12 deficiency secondary to pernicious anemia. The patient responded rapidly to vitamin B12 supplementation and clinical manifestations of RLS resolved, suggesting a possible causal relationship.

Risk analysis of air pollutants and types of anemia: a UK Biobank prospective cohort study.

Previous studies have suggested that exposure to air pollutants may be associated with specific blood indicators or anemia in certain populations. However, there is insufficient epidemiological data and prospective evidence to evaluate the relationship between environmental air pollution and specific types of anemia. We conducted a large-scale prospective cohort study based on the UK Biobank. Annual average concentrations of NO2, PM2.5, PM2.5-10, and PM10 were obtained from the ESCAPE study using the Land Use Regression (LUR) model. The association between atmospheric pollutants and different types of anemia was investigated using the Cox proportional hazards model. Furthermore, restricted cubic splines were used to explore exposure-response relationships for positive associations, followed by stratification and effect modification analyses by gender and age. After adjusting for demographic characteristics, 3-4 of the four types of air pollution were significantly associated with an increased risk of iron deficiency, vitamin B12 deficiency and folate deficiency anemia, while there was no significant association with other defined types of anemia. After full adjustment, we estimated that the hazard ratios (HRs) of iron deficiency anemia associated with each 10 μg/m3 increase in NO2, PM2.5, and PM10 were 1.04 (95%CI: 1.02, 1.07), 2.00 (95%CI: 1.71, 2.33), and 1.10 (95%CI: 1.02, 1.20) respectively. The HRs of folate deficiency anemia with each 10 μg/m3 increase in NO2, PM2.5, PM2.5-10, and PM10 were 1.25 (95%CI: 1.12, 1.40), 4.61 (95%CI: 2.03, 10.47), 2.81 (95%CI: 1.11, 7.08), and 1.99 (95%CI: 1.25, 3.15) respectively. For vitamin B12 deficiency anemia, no significant association with atmospheric pollution was found. Additionally, we estimated almost linear exposure-response curves between air pollution and anemia, and interaction analyses suggested that gender and age did not modify the association between air pollution and anemia. Our research provided reliable evidence for the association between long-term exposure to PM10, PM2.5, PM2.5-10, NO2, and several types of anemia. NO2, PM2.5, and PM10 significantly increased the risk of iron deficiency anemia and folate deficiency anemia. Additionally, we found that the smaller the PM diameter, the higher the risk, and folate deficiency anemia was more susceptible to air pollution than iron deficiency anemia. No association was observed between the four types of air pollution and hemolytic anemia, aplastic anemia, and other types of anemia. Although the mechanisms are not well understood, we emphasize the need to limit the levels of PM and NO2 in the environment to reduce the potential impact of air pollution on folate and iron deficiency anemia.

Measurement of the major ignored burden of multiple myeloma, pernicious anaemia and of other haematological conditions on partners and family members: A cross-sectional study.

Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions. To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure-16 (FROM-16). A cross-sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM-16. 183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM-16. The FROM-16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM-16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non-malignant conditions (mean = 11, SD = 7.4, n = 56, p < .01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM-16 score>16) on their quality of life. Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM-16, identify those most affected and should consider how to provide appropriate holistic support within routine practice.

Case report: Multiple autoimmune syndrome

This is a case of multiple autoimmune syndrome with the co-occurrence of vitiligo, pernicious anemia, celiac disease and autoimmune hepatitis is extremely rare. We are presenting a case is a 40-year-old woman with autoimmune hepatitis who is suffering from poor appetite, weight loss and skin lesions. Laboratory investigation shows hypochromic microcytic anemia, B12, and iron deficiency. The testing for parietal cell antibody was positive so pernicious anemia was diagnosed with positive Tissue transglutaminase antibody IgA so the diagnosis of celiac disease was confirmed.