Autoimmune cytopenias in pernicious anemia: A report of four cases and review of the literature

Abstract

Pernicious anemia appears to be autoimmune in origin and is associated with immune disorders of several organ systems. We report 4 patients with pernicious anemia and immune cytopenias, an association that may sometimes pose diagnostic problems unless specifically considered. Pernicious anemia coexisted with or was closely followed by idiopathic thrombocytopenic purpura in 3 patients and by autoimmune hemolytic anemia in a 4th patient. In addition to cobalamin therapy, all patients required corticosteroids (2 also received danazol), while 1 also required splenectomy. All 4 patients were women. The 3 patients with idiopathic thrombocytopenic purpura were also blood group 0 and were iron-deficient. Autoimmune cytopenias may occur in patients with treated or untreated pernicious anemia and require specific therapy.

Autoimmune Hemolytic Anemia After Cyanocobalamin Replacement in a Patient With a Previous Diagnosis of Pernicious Anemia: A Case Report

“…In patients with PA, DAT may be transiently positive when there is no adequate replacement of cyanocobalamin. These cases can be easily differentiated from AIHA since they present with low reticulocytes, and anemia improves rapidly after the initiation of cyanocobalamin replacement, and DAT becomes negative with treatment [ 18 - 19 ]. On the other hand, patients with AIHA usually present with increased reticulocytes and anemia does not improve until the start of immunosuppressive treatment, usually with glucocorticoids.…”

Severe Haemolytic Anaemia, a Rare Presentation of Nutritional Vitamin B12 Deficiency: A Case Report

“…However, descriptions of a nutritional vitamin B12 deficiency, without evidence of pernicious anaemia (normal upper gastrointestinal endoscopy), causing haemolysis are even scarcer. [4][5][6][7] Studies suggest, Vitamin B12 deficiency can present with a haemolytic picture in 1.5% of patients with elevated LDH, low haptoglobin, and elevated indirect bilirubin mostly due to ineffective erythropoietin and intramedullary destruction. [8][9][10] In Vit B12 deficiency anemia there is increased level of homocystein and it increases the risk of hemolysis.…”

A case of pernicious anemia requiring differential diagnosis of autoimmune hemolytic anemia complication

“…Rabinowitz et al classified these PA patients with positive DAT status into 2 groups: (a) hemolysis by autoimmune-mediated reaction and (b) hemolysis with non-autoimmune-mediated reaction [ 15 ]. The former group shows continuous positive DAT status, whereas the latter group shows inverted negative DAT status after PA treatment.…”