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Subtle Cobalamin Malabsorption in a Vegan Patient: Evolution Into Classic Pernicious Anemia With Anti-intrinsic Factor Antibody

Subtle Cobalamin Malabsorption in a Vegan Patient: Evolution Into Classic Pernicious Anemia With... Abstract • Classic pernicious anemia with abnormal Schilling test results developed in a previously described vegan patient who had coexisting subtle cobalamin malabsorption (demonstrable by abnormal ovalbumin-cobalamin absorption test results but normal Schilling test results). This suggests that the ovalbumin-cobalamin absorption test or a modified version may serve as a prodromal phenomenon to identify patients at risk for developing pernicious anemia. The patient's transformation was also accompanied by the appearance of serum anti-intrinsic factor antibody. A modified assay retrospectively detected this antibody a year earlier than did the standard assay, indicating that such modification enhances the sensitivity of this useful test. (Arch Intern Med 1982;142:2206-2207) References 1. Carmel R: Nutritional vitamin B12 deficiency: Possible contributory role of subtle vitamin B12 malabsorption. Ann Intern Med 1978;88:647-649.Crossref 2. Doscherholmen A, McMahon J, Ripley D: Inhibitory effect of eggs on vitamin B12 absorption: Description of a simple ovalbumin 57Co-vitamin B12 absorption test. Br J Haematol 1976;33:261-272.Crossref 3. Gottlieb C, Lau KS, Wasserman LR, et al: Rapid charcoal assay for intrinsic factor (IF), gastric juice unsaturated B12 binding capacity, antibody to IF, and serum unsaturated B12 binding capacity. Blood 1965;25:875-884. 4. Allen RH, Seetharam B, Allen NC, et al: Correction of cobalamin malabsorption in pancreatic insufficiency with a cobalamin analogue that binds with high affinity to R protein but not to intrinsic factor: In vivo evidence that a failure to partially degrade R protein is responsible for cobalamin malabsorption in pancreatic insufficiency. J Clin Invest 1978;61: 1628-1634.Crossref 5. Goldberg LS, Bluestone R: Hidden gastric autoantibodies to intrinsic factor in pernicious anemia. J Lab Clin Med 1970;75:449-456. 6. Zittoun J, Tulliez M, Estourmet B, et al: Humoral and cellular immunity to intrinsic factor in myasthenia gravis. Scand J Haematol 1979;23:442-448.Crossref 7. Ungar B, Whittingham S, Francis SM: Pernicious anaemia: Incidence and significance of circulating antibodies to intrinsic factor and to parietal cells. Australas Ann Med 1967;16:226-229. 8. Taylor KB, Roitt IM, Doniach D, et al: Autoimmune phenomena in pernicious anaemia: Gastric antibodies. Br Med J 1962;2:1347-1352.Crossref 9. Abels J, Bouma W, Jansz A, et al: Experiments on the intrinsic factor antibody in serum from patients with pernicious anemia. J Lab Clin Med 1963;61:893-906. 10. Samloff IM, Kleinman MS, Turner MD, et al: Blocking and binding antibodies to intrinsic factor and parietal cell antibody in pernicious anemia. Gastroenterology 1968;55:575-583. 11. Irvine WJ, Cullen DR, Mawhinney H: Natural history of autoimmune achlorhydric atrophic gastritis: A 1-15 year follow-up study. Lancet 1974; 2:482-485.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Subtle Cobalamin Malabsorption in a Vegan Patient: Evolution Into Classic Pernicious Anemia With Anti-intrinsic Factor Antibody

Archives of Internal Medicine , Volume 142 (12) – Nov 1, 1982

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340250172029
Publisher site
See Article on Publisher Site

Abstract

Abstract • Classic pernicious anemia with abnormal Schilling test results developed in a previously described vegan patient who had coexisting subtle cobalamin malabsorption (demonstrable by abnormal ovalbumin-cobalamin absorption test results but normal Schilling test results). This suggests that the ovalbumin-cobalamin absorption test or a modified version may serve as a prodromal phenomenon to identify patients at risk for developing pernicious anemia. The patient's transformation was also accompanied by the appearance of serum anti-intrinsic factor antibody. A modified assay retrospectively detected this antibody a year earlier than did the standard assay, indicating that such modification enhances the sensitivity of this useful test. (Arch Intern Med 1982;142:2206-2207) References 1. Carmel R: Nutritional vitamin B12 deficiency: Possible contributory role of subtle vitamin B12 malabsorption. Ann Intern Med 1978;88:647-649.Crossref 2. Doscherholmen A, McMahon J, Ripley D: Inhibitory effect of eggs on vitamin B12 absorption: Description of a simple ovalbumin 57Co-vitamin B12 absorption test. Br J Haematol 1976;33:261-272.Crossref 3. Gottlieb C, Lau KS, Wasserman LR, et al: Rapid charcoal assay for intrinsic factor (IF), gastric juice unsaturated B12 binding capacity, antibody to IF, and serum unsaturated B12 binding capacity. Blood 1965;25:875-884. 4. Allen RH, Seetharam B, Allen NC, et al: Correction of cobalamin malabsorption in pancreatic insufficiency with a cobalamin analogue that binds with high affinity to R protein but not to intrinsic factor: In vivo evidence that a failure to partially degrade R protein is responsible for cobalamin malabsorption in pancreatic insufficiency. J Clin Invest 1978;61: 1628-1634.Crossref 5. Goldberg LS, Bluestone R: Hidden gastric autoantibodies to intrinsic factor in pernicious anemia. J Lab Clin Med 1970;75:449-456. 6. Zittoun J, Tulliez M, Estourmet B, et al: Humoral and cellular immunity to intrinsic factor in myasthenia gravis. Scand J Haematol 1979;23:442-448.Crossref 7. Ungar B, Whittingham S, Francis SM: Pernicious anaemia: Incidence and significance of circulating antibodies to intrinsic factor and to parietal cells. Australas Ann Med 1967;16:226-229. 8. Taylor KB, Roitt IM, Doniach D, et al: Autoimmune phenomena in pernicious anaemia: Gastric antibodies. Br Med J 1962;2:1347-1352.Crossref 9. Abels J, Bouma W, Jansz A, et al: Experiments on the intrinsic factor antibody in serum from patients with pernicious anemia. J Lab Clin Med 1963;61:893-906. 10. Samloff IM, Kleinman MS, Turner MD, et al: Blocking and binding antibodies to intrinsic factor and parietal cell antibody in pernicious anemia. Gastroenterology 1968;55:575-583. 11. Irvine WJ, Cullen DR, Mawhinney H: Natural history of autoimmune achlorhydric atrophic gastritis: A 1-15 year follow-up study. Lancet 1974; 2:482-485.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1982

References