A patient with behavioral alterations due to pernicious anemia
Paciente con anemia perniciosa y cambios comportamentales
Article Sidebar
PDF (Español (España))
FLIP
HTML (Español (España))
EPUB (Español (España))
Main Article Content
Abstract
Pernicious anemia is a hematologic condition characterized by anemia with an increased mean corpuscular volume, secondary to impaired vitamin B12 absorption due to lack of intrinsic factor. It may be associated with the destruction of parietal gastric cells or the presence of anti-intrinsic factor antibodies which generates decreased serum levels of cyanocobalamin and impair DNA and RNA synthesis. Given it involves the three cell lines it may have a varied symptomatology. Main manifestations are seen in the central and peripheral nervous system and gastrointestinal system. Diagnosis is based on finding low cyanocobalamin serum levels, associated with gastric mucosa anomalies due to atrophic gastritis, which must be confirmed by a biopsy. A case is described in a 68 year old female patient with behavioral alterations and cognitive impairment. Hemogram showed pancytopenia and anemia, increased mean corpuscular volume, as well as decreased serum vitamin B12 level and an endoscopy evidenced chronic erythematous atrophic gastritis. She received vitamin B12 therapy with full cognitive recovery and reversal of behavioral alterations.
Downloads
Article Details
References
Lahner E, Annibale B. Pernicious anemia: new insights from a gastroenterological point of view. World J Gastroenterol 2009;15(41):5121-8.
Contreras E RJ, Vallejo R, Zúñiga L. Anemia perniciosa: descripción de un caso clínico. Rev Col Gastroenterol. 2008;23(1):83-8.
Hoffbrand V, Provan D. ABC of clinical haematology. Macrocytic anaemias. BMJ. 1997;314 (7078):430-3.
van Driel IR, Tu E, Gleeson PA. Autoimmune Gastritis and Pernicious Anemia. In: Rose NR, Mackay IR, editors. The Autoimmune Diseases (Fifth Edition). Boston: Academic Press; 1998. p. 619-31.
Feldman M, Lee EL. Gastritis and other gastropathies. In: Feldman M, Friedman L, Brandt L, editors. Sleisenger & Fordtran's gastrointestinal and liver disease: pathophysiology, diagnosis, management. 7 ed. Philadelphia: Elsevier; 2002. p. 810-27
Romero J SC, Sánchez C, Acosta L. Anemia Megaloblastica: Revisión bibliográfica. Revista de Posgrado de la VIa Cátedra de Medicina. 2008;177:17-21.
Mtvarelidze ZG, Kvezereli-Kopadze AN, Kvezereli-Kopadze MA. [Megaloblastic-vitamin B12 deficiency anemia in childhood]. Georgian Med News. 2009;170:57-60.
D'Elios MM, Appelmelk BJ, Amedei A, Bergman MP, Del Prete G. Gastric autoimmunity: the role of Helicobacter pylori and molecular mimicry. Trends Mol Med. 2004;10(7):316-23.
Amedei A, Bergman MP, Appelmelk BJ, Azzurri A, Benagiano M, Tamburini C, et al. Molecular mimicry between Helicobacter pylori antigens and H+, K+ --adenosine triphosphatase in human gastric autoimmunity. J Exp Med. 2003;198(8):1147-56.
Fernando MM, Stevens CR, Walsh EC, De Jager PL, Goyette P, Plenge RM, et al. Defining the role of the MHC in autoimmunity: a review and pooled analysis. PLoS genet. 2008;4(4):e1000024.
Forrellat Barrios M, Gómis Hernández I, Gautier du Défaix Gómez H. Vitamina B12: metabolismo y aspectos clínicos de su deficiencia. Rev Cubana Hematol Inmunol Hemoter 1999;15(3):159-74.
Tosetti C, Stanghellini V, Tucci A, Poli L, Salvioli B, Biasco G, et al. Gastric emptying and dyspeptic symptoms in patients with nonautoimmune fundic atrophic gastritis. Dig Dis Sci. 2000;45(2):252-7.
Seppä K, Heinilä K, Sillanaukee P, Saarni M. Evaluation of macrocytosis by general practitioners. J Stud Alcohol. 1996;57(1):97-100.
Kaferle J, Strzoda CE. Evaluation of macrocytosis. Am Fam Physician. 2009;79(3):203-8.
Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med 1994;96(3):239-46.
Vaananen H, Vauhkonen M, Helske T, Kaariainen I, Rasmussen M, Tunturi-Hihnala H, et al. Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study. Eur J Gastroenterol Hepatol. 2003;15(8):885-91.
Annibale B, Lahner E, Fave GD. Diagnosis and management of pernicious anemia. Curr Gastroenterol Rep 2011;13(6):518-24. doi: 10.1007/s11894-011-0225-5
Lahner E, Norman GL, Severi C, Encabo S, Shums Z, Vannella L, et al. Reassessment of intrinsic factor and parietal cell autoantibodies in atrophic gastritis with respect to cobalamin deficiency. The American journal of gastroenterology. 2009;104(8):2071-9. doi: 10.1038/ajg.2009.231
Carmel R, Perez-Perez GI, Blaser MJ. Helicobacter pylori infection and food-cobalamin malabsorption. Dig Dis Sci 1994;39(2):309-14.
Pruthi RK, Tefferi A. Pernicious anemia revisited. Mayo Clin Proc. 1994;69(2):144-50.