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home:diseases:pernicious_anemia [01.11.2019] – [Caution] sallieqhome:diseases:pernicious_anemia [09.14.2022] (current) – external edit 127.0.0.1
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-[[http://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360|Mayo Clinic overview]] +[[https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360|Mayo Clinic overview]] 
  
 Normal human gastric juice contains an "intrinsic factor" that, given simultaneously with vitamin B12 causes erythropoiesis  (production of  red blood cells). Normal human gastric juice contains an "intrinsic factor" that, given simultaneously with vitamin B12 causes erythropoiesis  (production of  red blood cells).
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 Breastfed infants of strict vegetarian mothers also are at risk for pernicious anemia. These infants can develop anemia within months of being born. Breastfed infants of strict vegetarian mothers also are at risk for pernicious anemia. These infants can develop anemia within months of being born.
  
-Gastric parietal cells produce two essential biologics: intrinsic factor and HCl acid. Pernicious anemia is a consequence of intrinsic factor loss and neutralizing intrinsic factor antibody that impairs cobalamin absorption.    (({{pubmed>long:27538411}})) +Gastric parietal cells produce two essential biologics: intrinsic factor and HCl acid. Pernicious anemia is a consequence of intrinsic factor loss and neutralizing intrinsic factor antibody that impairs cobalamin absorption.    (({{pmid>long:27538411}})) 
  
-[[https://www.ncbi.nlm.nih.gov/pubmed/28164751|Aspects in Diagnosis.]]  (({{pubmed>long:28164751}})) +[[https://www.ncbi.nlm.nih.gov/pubmed/28164751|Aspects in Diagnosis.]]  (({{pmid>long:28164751}})) 
  
-Large intakes of folic acid may delay the diagnosis of vitamin B-12 deficiency, which could lead to irreversible neuropathy.   (({{pubmed>long:17921401}}))  +Large intakes of folic acid may delay the diagnosis of vitamin B-12 deficiency, which could lead to irreversible neuropathy.   (({{pmid>long:17921401}}))  
  
- This review discusses the usefulness and limitations of current biomarkers of B12 status in newborn screening, infant and adult diagnostics, the algorithms utilized to diagnose B12 deficiency and unusual findings of vitamin B12 status in various human disorders.   (({{pubmed>long:27446930}}))  + This review discusses the usefulness and limitations of current biomarkers of B12 status in newborn screening, infant and adult diagnostics, the algorithms utilized to diagnose B12 deficiency and unusual findings of vitamin B12 status in various human disorders.   (({{pmid>long:27446930}}))  
  
  
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 ==== Laboratory findings ==== ==== Laboratory findings ====
  
-[[http://www.discoverymedicine.com/Thein-H-Oo/2017/09/challenging-clinical-presentations-of-pernicious-anemia/|Differing  presentations]] +[[https://www.discoverymedicine.com/Thein-H-Oo/2017/09/challenging-clinical-presentations-of-pernicious-anemia/|Differing  presentations]] 
  
  
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 A high level of blood serum homocysteine (known as "homocysteinemia") is associated with pernicious anemia. Because supplementation of the B vitamins lower levels of homocysteine, one common intervention for altering this risk factor is to supplement patients at risk for cardiovascular disease with folic acid (B<sub>9</sub>), pyridoxine (B<sub>6</sub>), and cyanocobalamin (B<sub>12</sub>). In fact,  interventions designed to lower levels of homocysteine with high-dose supplementation of the B vitamins have been equivocal, in some cases, seeming to exacerbate disease. A high level of blood serum homocysteine (known as "homocysteinemia") is associated with pernicious anemia. Because supplementation of the B vitamins lower levels of homocysteine, one common intervention for altering this risk factor is to supplement patients at risk for cardiovascular disease with folic acid (B<sub>9</sub>), pyridoxine (B<sub>6</sub>), and cyanocobalamin (B<sub>12</sub>). In fact,  interventions designed to lower levels of homocysteine with high-dose supplementation of the B vitamins have been equivocal, in some cases, seeming to exacerbate disease.
  
-  * A 2010 study by House //et al.// has shown substantial adverse outcomes associated with high-dose B vitamins in patients with advanced diabetic nephropathy.(({{pubmed>long:20424250}})) These side effects included myocardial infarction, stroke, revascularization, and all-cause mortality. According to [[http://www.medscape.com/viewarticle/731177|one commentator]], unless other explanations come to light in further analyses of the study, these findings make repetition of a similar trial in this high-risk patient group unethical. +  * A 2010 study by House //et al.// has shown substantial adverse outcomes associated with high-dose B vitamins in patients with advanced diabetic nephropathy.(({{pmid>long:20424250}})) These side effects included myocardial infarction, stroke, revascularization, and all-cause mortality. According to [[https://www.medscape.com/viewarticle/731177|one commentator]], unless other explanations come to light in further analyses of the study, these findings make repetition of a similar trial in this high-risk patient group unethical. 
-  * The Heart Outcomes Prevention Evaluation (HOPE-2) study, involved 5,522 patients with vascular disease or diabetes mellitus and found no effect of high-dose B6, B9 and B12 cosupplementation on death from cardiovascular disease, whereas the risk of stroke was decreased and the risk of unstable angina requiring hospitalization was increased.(({{pubmed>long:16531613}}))+  * The Heart Outcomes Prevention Evaluation (HOPE-2) study, involved 5,522 patients with vascular disease or diabetes mellitus and found no effect of high-dose B6, B9 and B12 cosupplementation on death from cardiovascular disease, whereas the risk of stroke was decreased and the risk of unstable angina requiring hospitalization was increased.(({{pmid>long:16531613}}))
  
-Marino //et al.// showed that eradication of //Helicobacter pylori// associated with gastritis reduced abnormally high levels of homocysteine.(({{pubmed>long:17005765}}))+Marino //et al.// showed that eradication of //Helicobacter pylori// associated with gastritis reduced abnormally high levels of homocysteine.(({{pmid>long:17005765}}))
  
  
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-Methylcobalamin and cyanocobalamin supplementation differ in their effects on gut bacteria   (({{pubmed>long:30505299}}))  +Methylcobalamin and cyanocobalamin supplementation differ in their effects on gut bacteria   (({{pmid>long:30505299}}))  
  
  
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 ===== Management ===== ===== Management =====
  
-Given that the B vitamins probably interfere with immune response to microbes, MP patients should as far as possible avoid taking supplemental doses of vitamin B12, **provided appropriate tests for B12 deficiency are made** with no finding of profoundly low B12.  (({{pubmed>long:17921401}}))+Given that the B vitamins probably interfere with immune response to microbes, MP patients should as far as possible avoid taking supplemental doses of vitamin B12, **provided appropriate tests for B12 deficiency are made** with no finding of profoundly low B12.  (({{pmid>long:17921401}}))
  
 ==== Caution ==== ==== Caution ====
  
-Myeloneuropathy is caused by inactivation of vitamin B12 by nitrous oxide. This syndrome can also be seen in patients with borderline vitamin B12 deficiency who have recently been anesthetized with nitrous oxide.    (({{pubmed>long:9613506}}))  +Myeloneuropathy is caused by inactivation of vitamin B12 by nitrous oxide. This syndrome can also be seen in patients with borderline vitamin B12 deficiency who have recently been anesthetized with nitrous oxide.    (({{pmid>long:9613506}}))  
  
  
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 {{tag>disease }} {{tag>disease }}
  
 +<nodisp>
 ===== Notes and comments ===== ===== Notes and comments =====
  
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 Lots of discussion about PA and B12 deficiency here: Lots of discussion about PA and B12 deficiency here:
-http://curemyth1.org/view_topic.php?id=2626&forum_id=2+https://curemyth1.org/view_topic.php?id=2626&forum_id=2
  
  
-Lots of content here:  http://www.curemyth1.org/forum2/2626.html+Lots of content here:  https://www.curemyth1.org/forum2/2626.html
  
  
  
-===== References =====+===== References =====</nodisp> 
home/diseases/pernicious_anemia.1547171109.txt.gz · Last modified: 01.11.2019 by sallieq
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