017 - Pernicious Anemia: clinical and diagnostic issues

Autor(s): P. Cappelletti

Issue: RIMeL - IJLaM, Vol. 5, N. 1, 2009 (MAF Servizi srl ed.)

Page(s): 17-23

According to epidemiological data, 15% of people aged more than 60 years had undiagnosed vitamin B12 (cobalamin) deficiency. Although only a minority of such persons display clinically symptoms or signs, the disease is potentially serious particularly from a neuropsychiatric and hematological perspective. Classic pernicious anemia is the cause of this deficiency in only a limited proportion of the elderly. Nevertheless is often unrecognized because of its subtle clinical manifestations and the difficulties in the diagnostic process. Some Authors emphasize the importance of analytic data such as MCV (Mean Corpuscolar Volume), peripheral blood smear examination, and patients’ medical history. But the limited sensitivity and specificity of morphological results justified the research of biochemical tests as plasma cobalamin, methylmalonic acid and holotranscobalamin measurements. The Schilling’s test is still considered the gold standard to prove the pathogenesis of pernicious anemia, but it is complex and no longer readily available. There are pros and cons about the different tests mainly aiming at the evaluation of the function of the gastric mucosa. Thus, empirical treatment, to assess any clinical response and to prevent neurological damage, may be pragmatically justifiable.
Key-words: pernicious anemia, vitamin B12 (cobalamin) deficiency, macrocytosis, Anti-Parietal Cell Autoantibody, anti-FI autoantibody, Schilling’s test.

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