Pernicious Anemia in Patients with Primary Biliary Cirrhosis, Autoimmune Hepatitis, and Chronic Viral Hepatitis

Abstract

Backgrounds: Cases of Pernicious Anemia (PA) with Autoimmune Liver Diseases (ALDs) or chronic viral hepatitis have been uncommon. There have been few articles regarding the associations between these diseases. Methods: A review of concomitant cases of PA in patients with ALDs, such as Auto Immune Hepatitis (AIH) or Primary Biliary Cirrhosis (PBC), and patients with chronic viral hepatitis with or without Interferon (IFN) treatment were conducted. Results: Six cases of concomitant PA and ALDs (five were PBC and one was AIH) and seven cases of chronic viral hepatitis (six were due to HCV, one was due to HBV; five cases were of IFN-induced PA and two were of PA without IFN treatment) have been reported. In these concomitant cases, serum vitamin B 12 deficiency was documented in all 13 cases and serum Intrinsic Factor Antibodies (IFA) were positive in 11 of 12 cases, excluding one case in which detection of IFA was not mentioned. Conclusions: Although concomitant cases of PA in patients with ALDs or chronic viral hepatitis have been rarely reported, PA should be considered in cases of progressive macrocytic anemia in these patients.

Autoimmune Hepatitis With Concomitant Pernicious Anemia: A Rare Association

“…AIH is known to be associated with several different autoimmune diseases. Approximately 20%-30% of patients with type 2 AIH have been reported to have additional autoimmune diseases [ 3 ], suggesting a genetic predilection that is well established in the medical literature. Advances in medical and immunological sciences have made it easier to detect patients with AIH.…”

“…Out of the 188 patients, only one female patient was found to have both to have AIH and PA [ 6 ]. Similarly, in a mini-review by Shizuma on concomitant cases of PA and autoimmune liver diseases, only one single case of AIH and concurrent PA was identified [ 3 ]. Both diseases have a high predilection for autoimmune thyroiditis and female predominance [ 6 ].…”