Pernicious Anemia: Time to Justify Endoscopic Monitoring?

Lahner, Edith; Esposito, Gianluca; Annibale, Bruno

doi:10.1016/j.cgh.2015.07.038

Cited by 5 publications

(3 citation statements)

References 7 publications

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Section: Pernicious Anemiamentioning

confidence: 99%

“…For this reason, many experts recommend that adults with PA undergo endoscopic surveillance at baseline and every 3 to 5 years for life, although this practice is not universally accepted. 25 Food-bound cobalamin malabsorption. FCBM syndrome is characterized by the inability to release Cbl from food or intestinal binding-proteins, generally as a consequence of achlorhydria, in the presence of normal ileal mucosa.…”

Section: Prevalence Of Cbl Deficiency (Cbld) In the Elderlymentioning

confidence: 99%

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Cobalamin Deficiency in the Elderly

Marchi

Busti

Zidanes

et al. 2020

Mediterr J Hematol Infect Dis

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Older people are at risk for cobalamin (vitamin B12) deficiency because of a number of common disorders (e.g. autoimmune gastritis) and drugs (e.g. antacids) that may alter its absorption and utilization. The prevalence of cobalamin deficiency increases with age, resulting particularly elevated in frail and institutionalized subjects. At variance with common sense, the diagnosis is far from simple and requires a high degree of suspicion, due to heterogeneity and non-specificity of the signs and symptoms, ranging from macrocytosis (with or without anemia) to neuropsychiatric manifestations, that characterize several other aging-related disorders, like hematological malignancies, diabetes, hypothyroidism or vasculopathies. Furthermore, the detection of low levels of serum vitamin B12 appears poorly sensitive and specific. Other biomarkers, like serum homocysteine or methylmalonic acid, have improved the diagnostic possibilities but are expensive, not widely available and may be influenced by some confounders (e.g. folate deficiency, or chronic renal failure). Early recognition and treatment are crucial, since a proportion of patients develop severe complications, such as bone marrow failure and irreversible neurological impairment. High-dose oral treatment has proven to be as effective as the parenteral route even in subjects with malabsorption, ensuring the complete resolution in the majority of cases. In this review, we trace the essential role of cobalamin in humans, the possible causes and impact of deficiency, the diagnostic challenges and the therapeutic options, between old and emerging concepts, with a particular focus on the elderly.

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Section: Pernicious Anemiamentioning

confidence: 99%

Section: Prevalence Of Cbl Deficiency (Cbld) In the Elderlymentioning

confidence: 99%

Cobalamin Deficiency in the Elderly

Marchi

Busti

Zidanes

et al. 2020

Mediterr J Hematol Infect Dis

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“…It has been linked to gastric neoplasia like adenocarcinomas, lymphomas and carcinoid syndromes. 6,7 In the past, PA was considered rare in blacks, but with increasing reports, it is obvious that the perceived rarity was due to missed-diagnosis of early disease, occasioned by the absence of dreaded neuropsychiatric and haematologic features. 4,8,9 The anaemia of VB12 and folate deficiency is megaloblastic.…”

Section: Introductionmentioning

confidence: 99%

Cutaneous hyperpigmentation as a diagnostic marker of vitamin B12 deficiency: a case report

2022

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<p>Cutaneous hyperpigmentation and glossitis are recognized but often overlooked early signs of vitamin B12 deficiency (VB12D). Pernicious anaemia is the most common cause of VB12D. Many clinicians miss the diagnosis of this potentially fatal but treatable condition in the absence of the more often reported life-threatening neuropsychiatric and haematologic features, notwithstanding the concomitant presence of characteristic cutaneous signs. These apperceptions of conspicuous and early dermatologic signs lead to diagnostic delay, which can result in dire consequences for the patient. We report the case of a 24-year-old young woman who for two years had repeated blood transfusions, iron supplementation and haematinics on account of anaemia of undetermined aetiology of a yet to be determined aetiology, despite the simultaneous presence of a constellation of glaring dermatologic clues to vitamin B12 deficiency. Following diagnosis and the institution of the appropriate therapy, the patient made remarkable improvement with a reversal of pigmentation and correction of the anaemia within a month. She continues to see the haematologists for follow-up.</p>

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