False-normal vitamin B12 results in a patient with pernicious anaemia

Wainwright, Patrick; Narayanan, Srinivasan; Cook, Paul

doi:10.1016/j.clinbiochem.2015.08.009

Cited by 14 publications

(9 citation statements)

References 8 publications

(9 reference statements)

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“…When high suspicion of PA is present, normal vitamin B12 level should be followed by homocysteine (HCys) and methylmalonic acid (MMA) measurements. 46 However, it has also been shown that the serum levels of all three tests (vitamin B12, HCys and MMA) can fluctuate over time and even be normal in cobalamin-responsive disorders. 47 …”

Section: Diagnosismentioning

confidence: 99%

Autoimmune atrophic gastritis: current perspectives

Minalyan¹,

Benhammou²,

Artashesyan³

et al. 2017

CEG

108

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At present there is no universally accepted classification for gastritis. The first successful classification (The Sydney System) that is still commonly used by medical professionals was first introduced by Misiewicz et al in Sydney in 1990. In fact, it was the first detailed classification after the discovery of Helicobacter pylori by Warren and Marshall in 1982. In 1994, the Updated Sydney System was proposed during the International Workshop on the Histopathology of Gastritis followed by the publication in The American Journal of Surgical Pathology by Dixon et al. Using the new classification, distinction between atrophic and nonatrophic gastritis was revised, and the visual scale grading was incorporated. According to the Updated Sydney System Classification, atrophic gastritis is categorized into multifocal (H. pylori, environmental factors, specific diet) and corpus-predominant (autoimmune). Since metaplasia is a key histological characteristic in patients with atrophic gastritis, it has been recommended to use the word “metaplastic” in both variants of atrophic gastritis: autoimmune metaplastic atrophic gastritis (AMAG) and environmental metaplastic atrophic gastritis. Although there are many overlaps in the course of the disease and distinction between those two entities may be challenging, the aim of this review article was to describe the etiology, epidemiology, pathogenesis, diagnosis, clinical manifestations and treatment in patients with AMAG. However, it is important to mention that H. pylori is the most common etiologic factor for the development of gastritis in the world.

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Section: Diagnosismentioning

confidence: 99%

Autoimmune atrophic gastritis: current perspectives

Minalyan¹,

Benhammou²,

Artashesyan³

et al. 2017

CEG

108

View full text Add to dashboard Cite

show abstract

“…Among previous postulated theories regarding the mechanism for pernicious anemia, chronic Helicobacter pylori infection can potentially lead to gastric inflammation, gastric atrophy, and intestinal metaplasia. These changes can predispose to gastric carcinoid and adenocarcinoma (1, 2). Therefore, continuous surveillance every 3 years in patients with pernicious anemia and Helicobacter pylori infection with endoscopy is strongly recommended (3).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, intramedullary cell death due to arrest of various precursor cells in hypercellular bone marrow causes release of LDH and low haptoglobin levels resulting in a presentation of similar to microangiopathic hemolytic anemia (5). Patients who present with normal vitamin B12 levels, but show clinical signs and symptoms of pernicious anemia, should have functional assays like methylmalanoic acid (MMA) and homocysteine levels checked (2). It is noted that competitive binding assays are susceptible to interference due to anti-IF antibodies resulting in false normal vitamin B12 levels (2).…”

Section: Discussionmentioning

confidence: 99%

“…Patients who present with normal vitamin B12 levels, but show clinical signs and symptoms of pernicious anemia, should have functional assays like methylmalanoic acid (MMA) and homocysteine levels checked (2). It is noted that competitive binding assays are susceptible to interference due to anti-IF antibodies resulting in false normal vitamin B12 levels (2). MMA is mildly elevated in 30% of healthy patients, 15% of elderly and in renal failure patients.…”

Section: Discussionmentioning

confidence: 99%

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A case of asymptomatic pancytopenia with clinical features of hemolysis as a presentation of pernicious anemia

Kollipara

Brine

Gemmel

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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Pernicious anemia is an autoimmune disease with a variety of clinical presentations. We describe a case of pernicious anemia presenting with pancytopenia with hemolytic features. Further workup revealed very low vitamin B12 levels and elevated methylmalonic acid. It is important for a general internist to identify pernicious anemia as one of the cause of pancytopenia and hemolytic anemia to avoid extensive workup. Pernicious anemia can present strictly with hematological abnormalities without neurological problems or vice versa as in our case.

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“…Consequently, the picture obtained when exploring folate metabolism is partial at best. For instance, total circulating B12 in serum is unreliable in some clinical conditions and practically useless as a method to detect true, functional B12 deficiency [ 142 ]. Most (80%) of B12 is bound in serum to haptocorrin, and a variable proportion (5%–20%) is bound to transcobalamin II and ready for tissue uptake (holotranscobalamin).…”

Section: Measuring the Impact Of Folate-related Deficiencies In Thmentioning

confidence: 99%

Nutrients in Energy and One-Carbon Metabolism: Learning from Metformin Users

et al. 2017

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Metabolic vulnerability is associated with age-related diseases and concomitant co-morbidities, which include obesity, diabetes, atherosclerosis and cancer. Most of the health problems we face today come from excessive intake of nutrients and drugs mimicking dietary effects and dietary restriction are the most successful manipulations targeting age-related pathways. Phenotypic heterogeneity and individual response to metabolic stressors are closely related food intake. Understanding the complexity of the relationship between dietary provision and metabolic consequences in the long term might provide clinical strategies to improve healthspan. New aspects of metformin activity provide a link to many of the overlapping factors, especially the way in which organismal bioenergetics remodel one-carbon metabolism. Metformin not only inhibits mitochondrial complex 1, modulating the metabolic response to nutrient intake, but also alters one-carbon metabolic pathways. Here, we discuss findings on the mechanism(s) of action of metformin with the potential for therapeutic interpretations.

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False-normal vitamin B12 results in a patient with pernicious anaemia

Cited by 14 publications

References 8 publications

Autoimmune atrophic gastritis: current perspectives

Autoimmune atrophic gastritis: current perspectives

A case of asymptomatic pancytopenia with clinical features of hemolysis as a presentation of pernicious anemia

Nutrients in Energy and One-Carbon Metabolism: Learning from Metformin Users

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