Treatment Of Pernicious Anemia Research Articles

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.

Research priorities in pernicious anaemia: James Lind Alliance Priority Setting Partnership

ObjectivesTo form a James Lind Alliance (JLA) Priority Setting Partnership (PSP) to determine research priorities related to the cause, diagnosis, treatment and management of pernicious anaemia (PA) from the perspectives...

Effects of vitamin B12 supplementation on pain relief in certain diseases - a literature review.

Based on current scientific reports, vitamin B12 (cobalamin), used in the treatment of pernicious anemia, may be used as a pain reliever. It has been shown to be effective in the treatment of different sorts of pain, including diabetic neuropathic, musculoskeletal, abdominal, back and spine ones, but also pain in Alzheimer's disease and pain ailments resulting from the development of neoplasms. In addition, it helps regeneration of the sensory nerves and relieves pain in eye diseases, for example in dry eye syndrome. This review summarizes recent research reports on pain-relieving properties of vitamin B12.

George Hoyt Whipple – a Nobel Prize winner, founder of the study on intestinal lipodystrophy and pernicious anemia: pages of life and work

The article focuses on the milestones of George Hoyt Whipple, who was a Nobel Prize Winner, pathologist, one of the major researchers of anemia, pigment metabolism, liver and pancreatic lesions, tuberculosis, parasitic diseases. He contributed significantly to biology and medicine. The authors briefly outline a biography of a well-known scientist, his significant contribution to the development of various branches of science, his landmark studies related to the role of the liver in the treatment of pernicious anemia. Modern aspects of the etio-pathogenesis of Whipple's disease are discussed.

Pathogenesis and treatment of pernicious anemia in the light of modern views

Malignant anemia, first described by Birmer in 1868 and 1871. and later developed by Ehrlich, according to its clinical data, according to the severity of the suffering itself, has long attracted the attention of clinicians and hematologists. A lot of theories were proposed that tried to explain the origin of this disease, there were a number of attempts to treat this suffering, which did not give any beneficial effect until recent years.

Impact on Biological Markers of a B12 Hypervitaminosis In the Context of a Refractory Vasoplegic Shock Treatment

Vitamin B12 or cobalamin is a water-soluble vitamin, essential for the functioning of the human body, especially for the nervous system. It is mainly found in animal products (meat, eggs, fish). Vitamin B12 is used for several years in the treatment of pernicious anemia, but also at very high doses in cardiogenic or septic shock with major vasoplegic syndrome [1-4].

How Do Patients Receiving Prescribed B12 Injections for the Treatment of PA Perceive Changes in Treatment During the COVID-19 Pandemic? A UK-Based Survey Study.

Pernicious anemia (PA) is a chronic condition that is usually treated using B12 injections. Due to the pandemic, many patients were prescribed an alternative oral B12 treatment. There is limited evidence that this is effective at managing symptoms of PA. The aim of this study was to document treatment changes across the United Kingdom and the impact on patient experience. An online survey explored how the treatment of PA has been managed during the early stages of the pandemic; responses were analyzed for a subsample of participants receiving prescribed B12 injections and where changes in treatment applied (n = 329) using content analysis. The most common reported change was the suspension of injections, with oral B12 being offered as an alternative treatment. Patients were concerned about the long-term impact that changes would have on their condition management, and many stated that they were dissatisfied with the level of care received. Those who were supported by health care providers to continue their usual treatment reported experiencing improved health and well-being. This study highlights the major impact of treatment changes on patient health outcomes and the need to further support health care professionals with PA management during and beyond the pandemic.

Pernicious Anemia: Early Detection of the Historical “Great Pretender"

Pernicious anemia (PA) is the late manifestation of autoimmune metaplastic atrophic gastritis (AMAG) characterized by the presence of anti-intrinsic factor with eventual decreased absorption of cyanocobalamin. Various clinical manifestations from subtle anemia to serious neurological symptoms gives PA notoriety as a “great pretender”. We present a case of an asymptomatic patient who was found to have severe gastritis with anemia leading to further evaluations revealing a chronic autoimmune disorder. A 52-year-old female with history of HTN, abnormal uterine bleeding, DM2 and anemia presented with abnormal labs. Colonoscopy completed 6 years ago for iron deficiency anemia found no etiology. Labs revealed Hb 6.0g/dl, Hct 17.5%, Plt 140,000/uL, MCV 114, RDW 27.2%, Iron 108μg/dL, ferritin 338ng/ml. Iron Saturation 32%, transferrin 258mg/dL, TIBC 335μg/dL, vitamin B12 <50pg/mL, Folate 22.8ng/mL, vitamin D 25-OH 13ng/mL. Fecal occult blood test was negative.EGD was performed to screen for (PA) and gastric malignancies which revealed frank blood in the gastric fundus, friable gastric mucosa, and erythematous mucosa in the pylorus. Pathology was consistent with autoimmune gastritis. Intrinsic factor antibody assay was positive. She was started on Cyanocobalamin injections, and continued on lifelong B12 supplementation. PA accounts for 20-50% of all cobalamin deficiencies in adults, and it is a complex disorder associated with hematological, gastric, immunological and neurological alterations. It has a prevalence 0.1% in the general population and is diagnosed in up to 15-25% of patients with AMAG. Disease progression includes symptoms ranging from fatigue and weakness, to atrophic glossitis, to more severe peripheral neuropa thies and subacute combined degeneration. Increase in MCV and hypersegmented neutrophils are usually the initial laboratory findings. This case illustrates the need to have early detection and timely treatment of PA induced vitamin B12 deficiency. Vitamin D displays immunomodulatory properties may be a risk factor. One case-control study revealed levels of vitamin D in autoimmune gastritis patients were significantly lower than in the general population. Evaluation by EGD and histopathology of AMAG is necessary due to its precancerous nature. Gastric carcinoid tumors have been observed in 4-9% of patients with AMAG and PA so continued surveillance should always remain a part of the patient's plan of care.2036_A Figure 1. Upper GI Bleed2036_B Figure 2. Gastritis2036_C Figure 3. Friable Gastric Mucosa

Deep vein thrombosis, an unreported first manifestation of polyglandular autoimmune syndrome type III.

SummaryA 71-year-old woman with severe right lower leg pain, edema and erythema was presented to the Emergency Department and was found to have an extensive deep vein thrombosis (DVT) confirmed by ultrasound. She underwent an extensive evaluation due to her prior history of malignancy and new hypercoagulable state, but no evidence of recurrent disease was detected. Further investigation revealed pernicious anemia (PA), confirmed by the presence of a macrocytic anemia (MCV=115.8fL/red cell, Hgb=9.0g/dL), decreased serum B12 levels (56pg/mL), with resultant increased methylmalonic acid (5303nmol/L) and hyperhomocysteinemia (131μmol/L), the presumed etiology of the DVT. The patient also suffered from autoimmune thyroid disease (AITD), and both antithyroglobulin and anti-intrinsic factor antibodies were detected. She responded briskly to anticoagulation with heparin and coumadin and treatment of PA with intramuscular vitamin B12 injections. Our case suggests that a DVT secondary to hyperhomocystenemia may represent the first sign of polyglandular autoimmune syndrome III-B (PAS III-B), defined as the coexistent autoimmune conditions AITD and PA. It is important to recognize this clinical entity, as patients may not only require acute treatment with vitamin B12 supplementation and prolonged anticoagulation, as in this patient, but may also harbor other autoimmune diseases.Learning pointsA DVT can be the first physical manifestation of a polyglandular autoimmune syndrome.Hyperhomocysteinemia secondary to pernicious anemia should be considered as an etiology of an unprovoked DVT in a euthyroid patient with autoimmune thyroid disease.Patients with DVT secondary to hyperhomocysteinemia should undergo screening for the presence of co-existent autoimmune diseases in addition to treatment with B12 supplementation and anticoagulation to prevent recurrent thromboembolism.

Patient journeys: diagnosis and treatment of pernicious anaemia.

Instigating a patient support group for patients with pernicious anaemia (PA) revealed dissatisfaction with its current diagnosis and treatment. The authors investigated the clinical features, patient experience of diagnosis and treatment of PA in the UK. A total of 889 patients registered with the PA Society support group completed an online survey or postal questionnaire. Outcome measures included clinical features, length of time to diagnosis and patient satisfaction with current treatment One-third of patients experienced symptoms for up to 1 year before diagnosis; 14% waited more than 10 years for a diagnosis. Neurological features were highly prevalent, the most common being memory loss and poor concentration. Nearly two-thirds of respondents were dissatisfied with current treatment; 10% used a non-licensed form of B12 to supplement their prescribed injections. The diagnosis and treatment of PA should be subject to a thorough review. This article discusses the patient survey and results and makes recommendations for how the diagnosis and treatment of PA may be evaluated.

Recommending OTC vitamin B12

Many clinical trials have proven that oral supplementation of vitamin B12 provides adequate replacement for deficiencies. Despite the consideration of poor absorption of the oral form due to lack of intrinsic factor or gastric acidity, oral supplementation may be preferred in most patients.1 Pharmacists should feel confident recommending oral supplementation of vitamin B12 to elderly patients for mild to moderate deficiencies and prevention or treatment of pernicious anemia.

Treatment of Pernicious Anemia

Treatment of Pernicious Anemia

TREATMENT OF PERNICIOUS ANEMIA BY A SPECIAL DIET*

The dietetic treatment of pernicious anemia is of more importance than hitherto generally recognized. Forty-five patients with pernicious anemia observed essentially in sequence are continuing to take a special diet that they have now been living on for from about six weeks to two years but which was temporarily omitted by three. This diet is composed especially of foods rich in complete proteins and iron—particularly liver —and containing an abundance of fruits and fresh vegetables and relatively low in fat. Following the diet, all the patients showed a prompt, rapid and distinct remission of their anemia, coincident with at least rather marked symptomatic improvement, except for pronounced disorders due to spinal cord degeneration. Improvement was often striking, so that where the red blood cell count averaged for all before starting the diet 1,470,000 per cubic millimeter, one month afterward it averaged 3,400,000; and for the twenty-seven cases observed from four to six months after the diet was begun, the average count was 4,500,000 per cubic millimeter. Patients having had two or more relapses showed on the average slightly lower red blood corpuscle counts about one and two months after commencing the diet than did those who had started it in their first or second relapse. Change in the frequency of bowel movements, temporary increase of reticulocytes in the peripheral blood, and decrease of the icterus index of the blood serum were among the earliest signs that heralded the patient’s better health. All the patients have remained to date in a good state of health except three, who discontinued the diet; two rapidly improved on resuming it and the other has just commenced it again. As the diet was advised for most of the patients less than eight months ago, enough time has not yet elapsed to determine whether or not the remissions will last any longer than in other cases.

A Case of Myasthenia Gravis associated Thymoma Complicated with Pure Red Cell Aplasia and Type 1 Diabetes Mellitus during the Treatment of Pernicious Anemia

A Case of Myasthenia Gravis associated Thymoma Complicated with Pure Red Cell Aplasia and Type 1 Diabetes Mellitus during the Treatment of Pernicious Anemia

Recognizing, treating and understanding pernicious anaemia.

Recognizing, treating and understanding pernicious anaemia.

Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification

Background: Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical.Objective: We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score <34) in senior participants in the 1999–2002 US National Health and Nutrition Examination Survey.Design: The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration <148 pmol/L or a serum methylmalonic acid concentration >210 nmol/L—the maximum of the reference range for serum vitamin B-12–replete participants with normal creatinine.Results: After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% CI: 1.7, 4.2], macrocytosis (OR: 1.8; 95% CI: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% CI: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate >59 nmol/L (80th percentile), as opposed to ≤59 nmol/L, was associated with anemia (OR: 3.1; 95% CI: 1.5, 6.6) and cognitive impairment (OR: 2.6; 95% CI: 1.1, 6.1). In the normal vitamin B-12 group, ORs relating high versus normal serum folate to these outcomes were <1.0 (Pinteraction < 0.05), but significantly <1.0 only for cognitive impairment (0.4; 95% CI: 0.2, 0.9).Conclusion: In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.

Effects of oral crystalline cyanocobalamin 1000 μg/d in the treatment of pernicious anemia: An open-label, prospective study in Ten Patients

Background: Standard treatment of cobalamin (vitamin B 12) deficiency involvesregular (1000 μg/mo) IM cyanocobalamin administration. It has been suggested that high-dose (>2000 μg/d) oral cyanocobalamin may be effective in patients with pernicious anemia. Objective: The aim of this study was to assess the efficacy and tolerability of oral crystalline cyanocobalamin 1000 μg/d in patients with cobalamin deficiency related to established pernicious anemia. Methods: This open-label, prospective study was conducted at StrasbourgUniversity Hospital, Strasbourg, France. Patients aged ≥18 years with well-documented cobalamin deficiency related to pernicious anemia were enrolled. Patients received crystalline cyanocobalamin 1000 μg QD PO (capsule) for at least 3 months. Serum cobalamin, folate, iron, and homocysteine concentrations were measured, and a complete blood count was obtained, before (month 0; baseline) and after treatment. Results: Ten patients (7 women, 3 men; mean [SD] age, 72.1 [15.5] years) entered the study. After 3 months of treatment, serum cobalamin concentration increased in all 9 patients in whom it was measured (mean [SD] increase, 117.4 [30.8] pg/mL; P < 0.001 vs baseline). Serum cobalamin concentrations were normalized (>200 pg/mL) in 6 patients. The serum cobalamin concentration was unavailable in 1 patient because of technical problems. Eight patients had increased hemoglobin concentrations (mean [SD] increase, 2.5 [2.4] g/dL; P < 0.01 vs baseline). All 10 patients had decreased mean erythrocyte corpuscular volumes (mean [SD] decrease, 10.4 [6.2] fL; P < 0.003 vs baseline). Four patients received concomitant blood transfusions or folate and iron supplementation. Three patients experienced clinical improvement in paresthesia, reflex abolition, or combined medullary sclerosis (each, 1 patient). Conclusion: The results of this small study in patients with cobalamin deficiencyrelated to pernicious anemia suggest that oral crystalline cyanocobalamin 1000 μg/d may be an effective treatment

Pernicious Anemia Revisited

We discuss the pathophysiologic mechanisms, clinical features, diagnosis, and treatment of pernicious anemia (PA). A review of the clinical applications of the diagnostic and therapeutic progress of PA is presented. A patient with PA may have a wide range of initial complaints that affect various organ systems or may be entirely asymptomatic. Hematologic variables may be normal in patients with cobalamin (Cbl) deficiency. Because of the difficulties in diagnosing Cbl deficiency, alternatives to measuring Cbl have been sought. Determining the urinary methylmalonic acid level is a less invasive, more practical, and, possibly, more sensitive method. The Schilling test is performed for assessment of the absorption of orally ingested radiolabeled crystalline cyano-Cbl; results should be interpreted cautiously. Vitamin B12 therapy should be lifelong. It is customarily administered intramuscularly. Other routes of administration have been studied. PA is one of the most treatable hematologic disorders.

Oral cobalamin for pernicious anemia. Medicine's best kept secret?

THE TREATMENT of pernicious anemia with cobalamin is one of medicine's great success stories. However, the usual practice of giving the drug as an intramuscular injection has several drawbacks. Injections can be painful, difficult to provide for some patients who are elderly or living alone, 1 and costly if given by health professionals. 2 It is therefore not surprising that the search for an oral preparation began soon after cobalamin was isolated and introduced for parenteral use in 1948. Preparations containing oral intrinsic factor were tried, but antibody production caused some patients to become refractory and relapse. 3 Other studies revealed that a small but constant proportion of an oral dose of cyanocobalamin was absorbed without intrinsic factor, so that by sufficiently increasing the dose, adequate absorption could be attained. 4,5 Promising results from early studies of oral cyanocobalamin therapy led to the use of increasingly larger doses, and several

Oral Cobalamin for Pernicious Anemia

THE TREATMENT of pernicious anemia with cobalamin is one of medicine's great success stories. However, the usual practice of giving the drug as an intramuscular injection has several drawbacks. Injections can be painful, difficult to provide for some patients who are elderly or living alone, 1 and costly if given by health professionals. 2 It is therefore not surprising that the search for an oral preparation began soon after cobalamin was isolated and introduced for parenteral use in 1948. Preparations containing oral intrinsic factor were tried, but antibody production caused some patients to become refractory and relapse. 3 Other studies revealed that a small but constant proportion of an oral dose of cyanocobalamin was absorbed without intrinsic factor, so that by sufficiently increasing the dose, adequate absorption could be attained. 4,5 Promising results from early studies of oral cyanocobalamin therapy led to the use of increasingly larger doses, and several