Subacute combined degeneration of the spinal cord with concomitant autoimmune disease: report of 2 cases

The etiology of subacute combined degeneration (SCD) of the spinal cord is closely associated with vitamin B12 (VitB12) deficiency. The clinical manifestations of SCD are complex and vary substantially. Due to some SCD patients with atypical manifestations and concomitant autoimmune disorders, the probability of misdiagnosis and missed diagnosis is still relatively high in the early stage. We report the cases of two patients who were missed or misdiagnosed at another hospital because of the normal initial VitB12 level and partial overlap of clinical manifestations, finally diagnosed as SCD with atypical manifestations and concomitant autoimmune disorders, pharyngeal-cervical-brachial Guillain-Barre syndrome in Case 1 and SCD with autoimmune thyroiditis in Case 2. After undergoing corresponding treatment, death was reported in Case 1 and improvement in Case 2. Analysis of the clinical manifestations and investigation of the underlying pathogenesis in such patients could help improve the rate of early diagnosis and allow timely treatment of SCD, thereby preventing disease progression and poor clinical outcomes.

The investigation of the positive rate of intrinsic factor antibody and deficiency rate of vitamin B(12) in normal physical examination population / 中华血液学杂志

Objective: To explore the positive rate of intrinsic factor antibody (IFAb) and level of vitamin B(12) (VitB(12)) in normal physical examination population and the possible relation between IFAb, VitB12 and sex, age, number of RBC, HGB and MCV. Methods: A total of 1 427 people who came to Peking Union Medical Colleague Hospital (PUMCH) for physical examination were enrolled. There were 758 males with average age of (52.5±14.5) years-old and 669 females with average age of (50.3±14.3) year-old. Beckman DxI800 automatic biochemical-immune analyzer and corollary reagents were used to analyze the level of serum IFAb and VitB(12). The results in different sex, age were documented and their correlation with the value of whole blood cell count was tested later on. Results: Among the 1 427 normal subjects, 66 (4.63%) were positive for IFAb. The positive rate for IFAb in the population≥40 years-old was higher than those<40 years-old (5.66% vs 1.48%, χ(2)=7.46, P=0.006). The deficiency rate of VitB(12) in the population<40 years-old, 40-59 years-old and ≥60 years-old was 2.22%, 2.51% and 5.50%, respectively (χ(2)=8.55, P=0.014). There were no difference between people with different sex in the positive rate of IFAb (5.15% for males and 4.04% for females, χ(2)=0.99, P=0.320) or in the deficiency rate of VitB(1)2 (3.83% for males and 2.69% for females, χ(2)=1.44, P=0.230). The results of multiple linear regression showed that HGB level of IFAb positive subjects was 3.05 g/L lower on average than those of IFAb negative, but IFAb had no effect on both RBC and MCV. There was no correlation between VitB(1)2 deficiency and HGB, RBC and MCV. Conclusion: The positive rate of IFAb and deficiency rate of VitB(1)2 increase as age increases. But the presence of VitB(12) deficiency is later than the positive findings of IFAb. IFAb showed some effects on the level of HGB, which may compensate the limitations of VitB(12) detection to some extent. It is necessary to check the IFAb and level of VitB(12) in people with middle or old ages.

The investigation of the positive rate of intrinsic factor antibody and deficiency rate of vitamin B12 in normal physical examination population / 中华血液学杂志

Objective@#To explore the positive rate of intrinsic factor antibody (IFAb) and level of vitamin B12 (VitB12) in normal physical examination population and the possible relation between IFAb, VitB12 and sex, age, number of RBC, HGB and MCV.@*Methods@#A total of 1 427 people who came to Peking Union Medical Colleague Hospital (PUMCH) for physical examination were enrolled. There were 758 males with average age of (52.5±14.5) years-old and 669 females with average age of (50.3±14.3) year-old. Beckman DxI800 automatic biochemical-immune analyzer and corollary reagents were used to analyze the level of serum IFAb and VitB12. The results in different sex, age were documented and their correlation with the value of whole blood cell count was tested later on.@*Results@#Among the 1 427 normal subjects, 66 (4.63%) were positive for IFAb. The positive rate for IFAb in the population≥40 years-old was higher than those<40 years-old (5.66% vs 1.48%, χ2=7.46, P=0.006). The deficiency rate of VitB12 in the population<40 years-old, 40-59 years-old and ≥60 years-old was 2.22%, 2.51% and 5.50%, respectively (χ2=8.55, P=0.014). There were no difference between people with different sex in the positive rate of IFAb (5.15% for males and 4.04% for females, χ2=0.99, P=0.320) or in the deficiency rate of VitB12 (3.83% for males and 2.69% for females, χ2=1.44, P=0.230). The results of multiple linear regression showed that HGB level of IFAb positive subjects was 3.05 g/L lower on average than those of IFAb negative, but IFAb had no effect on both RBC and MCV. There was no correlation between VitB12 deficiency and HGB, RBC and MCV.@*Conclusion@#The positive rate of IFAb and deficiency rate of VitB12 increase as age increases. But the presence of VitB12 deficiency is later than the positive findings of IFAb. IFAb showed some effects on the level of HGB, which may compensate the limitations of VitB12 detection to some extent. It is necessary to check the IFAb and level of VitB12 in people with middle or old ages.

Clinical and Epidemiological Features of 14 Cases of Pernicious Anemia on Tokunoshima Island / 日本プライマリ・ケア連合学会誌

<p><b>Objective: </b>To identify the clinical and epidemiological characteristics of pernicious anemia (PA) in patients treated at Miyagami hospital on Tokunoshima Island.</p><p><b>Methods: </b>We evaluated 14 patients with PA who were enrolled and treated from March 2009 to May 2014.</p><p><b>Results: </b>The majority of patients were older than 50 years of age and primarily consisted of elderly women. Routine medical examinations revealed macrocytic anemia in 6 of the 14 patients (43%), although they were clinically asymptomatic and subsequently diagnosed with PA. The average number of patients per year was reported to be 3 (95% confidence interval [CI]: 1.25-3.42).</p><p><b>Conclusions: </b>The annual incidence of PA per 100,000 individuals on Tokunoshima Island is possibly much higher than that previously reported in Japan. An increase in the elderly population, a negligence of the disease, and an ethnic and regional diversity may explain this discrepancy. As the annual incidence of PA may be higher than that previously reported, anemia must be carefully evaluated in the differential diagnosis of PA.</p>

A Multicenter Retrospective Analysis of the Clinical Features of Pernicious Anemia in a Korean Population

To determine the approximate incidence and clinical features of pernicious anemia in a Korean population, we retrospectively analyzed clinical data for patients with pernicious anemia who were diagnosed between 1995 and 2010 at five hospitals in Chungnam province. Ninety-seven patients were enrolled, who accounted for 24% of patients with vitamin B12 deficiency anemia. The approximate annual incidence of pernicious anemia was 0.3 per 100,000. The median age was 66 (range, 32-98) yr, and the male/female ratio was 1.25. Anemia-associated discomfort was the most common symptom (79.4%), followed by gastrointestinal and neurological symptoms (78.4% and 38.1%, respectively). Pancytopenia was found in 36 patients (37.1%), and autoimmune disorders were found in 15 patients (15.5%). Antibody to intrinsic factor was detected in 62 (77.5%) of 80 patients examined, and antibody to parietal cells was detected in 35 (43.2%) of 81 patients examined. Of the 34 patients who underwent tests for Helicobacter pylori, 7 (12.5%) were positive. The anemia-associated and gastrointestinal symptoms resolved completely in all patients after intramuscular injection of cobalamin, whereas neurological symptoms remained in some. In conclusion, pernicious anemia is less frequent in Koreans than in Western populations; however, the clinical features of this disorder in Koreans do not differ from those of Western cases.

Pernicious Anemia: A Retrospective Analysis of 22 Cases

BACKGROUND: Pernicious anemia is the most common cause of vitamin B12 deficiency in western populations, but to date, only case reports or small series dealing with this malady have been reported in Korea. This study describes the clinical characteristics of pernicious anemia in Koreans. METHODS: We retrospectively analyzed the clinical data for twenty-two Korean patients with pernicious anemia who were diagnosed during the period from 1995 to 2004 at Chungnam National University Hospital. RESULTS: Only two patients were diagnosed before 2000. The median age of the patients was 66 years and the male/female ratio was 1.8. Anemia-associated discomfort was the most common symptom (95.5%); this was followed by gastrointestinal and neurological symptoms (77.2% and 50.0%, respectively). Autoimmune disorders were found in five patients (22.7%). The median hemoglobin level was 7.0g/dL (range: 3.1~11.8g/dL) and pancytopenia was found in 12 patients (54.5%). The median serum vitamin B12 Level was 26pg/mL (range: 12~189pg/mL). Fifteen (78.9%) and eight (42.1%) of the 19 patients who underwent tests for antibodies were positive for anti-intrinsic factor and anti-parietal cell antibody, respectively. Nineteen of 21 patients who were treated with intramuscular cobalamin recovered from their cytopenia within 3 months. The gastrointestinal symptoms resolved completely for all the patients, while neurological symptoms remained for some of the patients. CONCLUSION: This study shows that the clinical features of pernicious anemia in Koreans are not different from those of the western cases. In addition, pernicious anemia is not a rare finding in Korea.