Subject(s)
Humans , Male , Adult , Percutaneous Coronary Intervention/economics , Anemia, Pernicious/diagnosis , Myocardial Infarction/diagnosis , Thromboembolism/diagnosis , Diagnosis, Differential , Anemia, Pernicious/complications , Anemia, Pernicious/mortality , Myocardial Infarction/complications , Myocardial Infarction/mortalityABSTRACT
Objetivo: Discriminar as variáveis de sexo e idade nos pacientes com anemia perniciosa; estudar seu perfil hematimétrico; verificar a prevalência de outras doenças autoimunes e anemia perniciosa; analisar a incidência da pancitopenia e sua relação com alterações laboratoriais comum na doença; e avaliar a frequência dos autoanticorpos anticélulas parietais e antifator intrínseco. Métodos: Estudo transversal descritivo, de base clínica e laboratorial, de 33 prontuários de pacientes com anemia perniciosa, diagnosticados em um ambulatório de hospital terciário de atenção à saúde, no período de junho de 2009 a junho de 2014. Para analisar a relação da presença e da ausência de pancitopenia com os níveis da enzima lactato desidrogenase e vitamina B12, foi utilizado o teste qui quadrado. O programa utilizado foi o software Epi Info, versão 7. Resultados: Na amostra, 63,6% eram mulheres, e a idade média geral foi de 47,3 anos. Doenças autoimunes estavam associadas em 30,3% dos pacientes. A pancitopenia esteve presente em 39,4% dos pacientes. Houve significância estatística na relação da pancitopenia com os níveis de enzima lactato desidrogenase (p<0,05). A prevalência do antifator intrínseco foi de 69,7% e dos autoanticorpos anticélulas parietais foi de 72,7%. Conclusão: A pancitopenia mostrou-se um achado significante na população com anemia perniciosa, assim como níveis elevado de LDH, acrescentando a anemia perniciosa como um diagnóstico diferencial de tais alterações laboratoriais.(AU)
Objective: To discriminate the gender and age variables in patients with pernicious anemia; to study erythrocyte profile; to check the prevalence of other autoimmune diseases and pernicious anemia; to analyze the incidence of pancytopenia and its relationship with common laboratory abnormalities in the disease; to evaluate the frequency of anti-gastric parietal cell antibodies, and anti-intrinsic factor antibodies. Methods: Descriptive, cross-sectional study of clinical and laboratorybased medical records of 33 patients with pernicious anemia diagnosed in an outpatient's department of a tertiary healthcare center, in the period between June 2009 and June 2014. To analyze the relationship between the presence and absence of pancytopenia with levels of lactate dehydrogenase enzyme and levels of Vitamin B12 we used the chi-squared test. The software used was Epininfo version 7. Results: The sample showed 63.6% women and 36.4% men with a mean age of 47.3 years. Autoimmune diseases were associated in 30.3% of the patients. Pancytopenia was present in 39.4% of patients. There was statistically significant relationship of pancytopenia with lactate dehydrogenase enzyme levels (p <0.05). The frequency of anti-intrinsic factor antibodies was 69.7%, and the antigastric parietal cell antibodies was 72.7%. Conclusion: Pancytopenia proved to be a significant finding among the population with pernicious anemia and high levels of LDH, which includes pernicious anemia as a differential diagnosis of such laboratory alterations.(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pancytopenia/complications , Pancytopenia/diagnosis , Autoimmune Diseases/epidemiology , Vitamin B 12/blood , Anemia, Pernicious/complications , Anemia, Pernicious/diagnosis , L-Lactate Dehydrogenase , Autoimmune Diseases/complications , Diagnosis, Differential , AntibodiesABSTRACT
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.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anemia, Pernicious/complications , Asian People , Autoimmune Diseases/complications , Gastrointestinal Diseases/complications , Helicobacter Infections/diagnosis , Helicobacter pylori , Isoantibodies/blood , Nervous System Diseases/complications , Parietal Cells, Gastric/immunology , Republic of Korea/epidemiology , Retrospective Studies , Vitamin B 12/bloodABSTRACT
A carência da vitamina B12 em muitas situaçoes manifesta-se também por alteraçoes neuropsiquiátricas, sendo a mais comum a degeneraçao combinada subaguda da medula espinhal. No sistema nervoso central a repercussao maior é na mielina, sendo a degeneraçao esponjosa e a desmielinizaçao difusa das colunas lateral e posterior da medula as mais típicas alteraçoes patológicas. O mesmo ocorre nos hemisférios cerebrais, sendo que anormalidades nas imagens por ressonância magnética sao esperadas. No entanto muito pouco tem sido relatado e a carência da cobalamina nao figura habitualmente na lista de diagnósticos diferenciais de lesoes desmielinizantes. Relatamos caso de anemia perniciosa com manifestaçoes neurológicas em que a ressonância magnética mostrou alteraçoes compatíveis com desmielinizaçao do feixe piramidal, consequentes, possivelmente, à carência da vitamina B12. Discutimos os achados neuropatológicos da hipovitaminose. Sugerimos que a degeneraçao combinada subaguda da medula deve fazer parte do diagnóstico diferencial radiológico das lesoes desmielinizantes no sistema nervoso central
Subject(s)
Humans , Female , Middle Aged , Anemia, Pernicious/complications , Brain Diseases/etiology , Demyelinating Diseases/etiology , Spinal Cord Diseases/etiology , Vitamin B 12 Deficiency/complications , Vitamin B 12/therapeutic use , Acute Disease , Anemia, Pernicious/drug therapy , Brain Diseases/drug therapy , Follow-Up Studies , Magnetic Resonance Spectroscopy , Vitamin B 12 Deficiency/drug therapyABSTRACT
Se informa que la diferenciación del steem cell primario en el precursor de la célula B y la célula plasmática ha sido bien estudiada en el hombre. Se expresa que la activación del linfocito B es detonada por estimulación antigénica que produce expansión clonal de un cierto tipo de célula con vistas a su diferenciación en célula plasmática y la síntesis ulterior de anticuerpos específicos contra dicho antígeno. Se destaca que la vitamina B12 es decisiva para que se produzca la rápida proliferación de cualquier línea celular, lo que origina por ejemplo, anemia perniciosa cuando ella no es absorbida por ausencia del factor intrínseco gástrico. Su déficit también compromete la expansión clonal de los linfocitos B en presencia de un estímulo antigénico adecuado, lo que originará una hipogammaglobulinemia, que se corrige con la administración de dicho elemento. Se presenta un paciente con anemia perniciosa e hipogammaglobulinemia, que desapareció una vez iniciado el tratamiento con vitamina B12. Se concluye que esta observación apoya los conceptos según los cuales algunos elementos, como el déficit de vitamina B12 podrían limitar la síntesis de anticuerpos aun en presencia de un sistema inmune normal y con una estimulación antigénica adecuada
Subject(s)
Middle Aged , Humans , Male , Agammaglobulinemia/complications , Anemia, Pernicious/complications , Vitamin B 12 DeficiencyABSTRACT
Pernicious anaemia (PA) has previously not been reported from Bangladesh. A case is described which had the typical clinical features of PA with subacute combined degeneration of the cord and polyneuropathy. The patient had typical macroovalocytosis, megaloblastic bone marrow and Schilling test result in the range of PA. Vitamin B12 level in the serum was markedly reduced. There was rapid clinical and haematological response to vitamin B12 therapy.
Subject(s)
Anemia, Pernicious/complications , Bangladesh , Elliptocytosis, Hereditary , Humans , Male , Middle Aged , Spinal Cord/pathology , Spinal Cord Diseases/etiology , Vitamin B 12/therapeutic useABSTRACT
Se presentan 75 casos de mala absorción tropical, 65 adultos y 10 niños, estudiados desde el año de 1968 en el Hospital San Juan de Dios de Bogotá. La mayoría de los pacientes provenían de Cundinamarca y del Distrito Especial de Bogotá. En todos hubo mala absorción de la D-xilosa y esteatorrea. La biopsia peroral de la mucosa intestinal practicada en 64, mostró atrofia de 1+ en 16, de 2+ en 30, de 3+ en 18 y en ninguno se observó atrofia de 4+. Se encontró anemia en 58 pacientes, la cual fue de tipo megaloblástico en 45 (60 por ciento), ocasionada a su vez por deficiencia de ácido fólico, en 4, de Vitamina B12 en 9 y de ácido fólico y Vitamina B12 en 32. Fueron hallazgos frecuentes además del peso bajo, la glositis, la carotinemia baja (<40ug/dl) la colesterolemia inferior a 150mg/dl y la albuminemia por debajo de 3.5 g/dl. Fueron tratados exitosamente con dieta balanceada, ácido fólico, Vitamina B12, tetraciclina o sulfas, en forma aislada o empleando combinaciones de estos medicamentos. En presencia de megaloblastosis la terapia ideal es el tratamiento "triconjugado" de Vitamina B12, ácido fólico y tetraciclina; solamente falleció un paciente, por tromboembolismo pulmonar. El diagnóstico diferencial debe hacerse principalmente con la enteropatía por Gluten y con la anemia perniciosa