Reassessment of Intrinsic Factor and Parietal Cell Autoantibodies in Atrophic Gastritis With Respect to Cobalamin Deficiency

A 28-year-old Caucasian male with Hashimoto’s disease and vitiligo presented with two weeks of dizziness on exertion following pharyngitis which was treated with prednisone 40 mg by mouth once a day for five days. Initial workup revealed anemia, elevated lactate dehydrogenase (LDH), and low haptoglobin. He underwent workup for causes of hemolytic anemia which was remarkable for a peripheral blood smear with hypersegmented neutrophils and low vitamin B12 levels concerning for pernicious anemia. Parietal cell and intrinsic factor antibodies were negative, and he then underwent an esophagogastroduodenoscopy with biopsy. The biopsy was negative for Helicobacter pylori, and the immunohistochemical stains were suggestive of chronic atrophic gastritis. He was started on vitamin B12 1,000 mcg intramuscular injections daily. His hemoglobin, LDH, and haptoglobin normalized. Given the absence of the parietal cell antibody and intrinsic factor antibody, this is a rare case of seronegative pernicious anemia.

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T1077 Occurrence of Intrinsic Factor and Parietal Cell Autoantibodies in Atrophic Body Gastritis Patients with or Without Pernicious Anemia

Gastroenterology ◽

10.1016/s0016-5085(08)62238-6 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-478

Author(s):

Edith Lahner ◽

Gary L. Norman ◽

Carola Severi ◽

Susan B. Encabo ◽

Zakera Shums ◽

...

Keyword(s):

Pernicious Anemia ◽

Parietal Cell ◽

Intrinsic Factor ◽

Parietal Cell Autoantibodies

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Family Study in Addisonian Pernicious Anemia

Blood ◽

10.1182/blood.v27.5.599.599 ◽

1966 ◽

Vol 27 (5) ◽

pp. 599-610 ◽

Cited By ~ 18

Author(s):

S. ARDEMAN ◽

I. CHANARIN ◽

A. JACOBS ◽

LORRAINE GRIFFITHS

Keyword(s):

Hydrochloric Acid ◽

Atrophic Gastritis ◽

Pernicious Anemia ◽

Parietal Cell ◽

Family Study ◽

Intrinsic Factor ◽

Gastric Biopsy ◽

Gastric Pathology ◽

Parietal Cell Antibodies ◽

Factor Secretion

Abstract Addisonian pernicious anemia was present in 6 of 9 siblings (Generation II). All 9 siblings had evidence of gastric pathology as judged by the presence of antibodies against parietal cells, abnormalities in the gastric biopsy, and diminution of secretion of acid and intrinsic factor. Parietal cell antibodies were present in 10 of 17 offspring of these 9 siblings who were available for study. Gastric biopsy in the older members of this generation (III) showed atrophic gastritis; some of the younger members showed superficial gastritis. Loss of intrinsic factor was always accompanied by loss of gastric secreting cells and there was no evidence that decline of intrinsic factor secretion occurred independently of hydrochloric acid.

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P.19.6 SERUM PEPSINOGEN I AND GASTRIN-17 LEVELS ARE PREDICTABLE OF ATROPHIC GASTRITIS IN PATIENTS WITH AUTOIMMUNE THYROIDITIS AND ANTI-GASTRIC PARIETAL CELL AUTOANTIBODIES

Digestive and Liver Disease ◽

10.1016/s1590-8658(12)60595-7 ◽

2012 ◽

Vol 44 ◽

pp. S209

Author(s):

S. Russo ◽

N. De Bortoli ◽

I. Martinucci ◽

E. Fiore ◽

A.T. Provenzale ◽

...

Keyword(s):

Atrophic Gastritis ◽

Parietal Cell ◽

Autoimmune Thyroiditis ◽

Serum Pepsinogen ◽

Gastric Parietal Cell ◽

Pepsinogen I ◽

Parietal Cell Autoantibodies

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COMBINED USE OF INTRINSIC FACTOR AND PARIETAL CELL AUTOANTIBODIES ARE USEFUL FOR THE DIAGNOSIS OF AUTOIMMUNE GASTRITIS

Digestive and Liver Disease ◽

10.1016/s1590-8658(09)60220-6 ◽

2009 ◽

Vol 41 ◽

pp. S86

Author(s):

E. Lahner ◽

G.L. Norman ◽

L. Vannella ◽

C. Pozzessere ◽

G. Delle Fave ◽

...

Keyword(s):

Parietal Cell ◽

Intrinsic Factor ◽

Autoimmune Gastritis ◽

Combined Use ◽

Parietal Cell Autoantibodies

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An Unusual Presentation of Pseudothrombotic Microangiopathy in a Patient with Autoimmune Atrophic Gastritis

Case Reports in Hematology ◽

10.1155/2016/1087831 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Alexandre Malek ◽

Roy Nasnas

Keyword(s):

Atrophic Gastritis ◽

White Blood Cells ◽

Intrinsic Factor ◽

Peripheral Blood Smear ◽

Blood Parameters ◽

Young Female ◽

Cobalamin Deficiency ◽

Caucasian Woman ◽

Case Presentation ◽

Autoimmune Atrophic Gastritis

Introduction. We hereby describe the case of a young female patient who presented with pseudothrombotic microangiopathy, as well as pancytopenia accompanied by autoimmune atrophic gastritis.Case Presentation. A 36-year-old Caucasian woman presented to the emergency department with fatigue and dyspnea on minimal exertion. Physical examination was unremarkable except for pallor and noninjected conjunctiva. Laboratory tests revealed high LDH and low hemoglobin, white blood cells, platelets, and haptoglobin. The peripheral blood smear showed schistocytes suggestive of pseudothrombotic microangiopathy. Low cobalamin level and hyperhomocysteinemia were also detected. Autoimmune atrophic gastritis was confirmed by gastric biopsy and positive anti-intrinsic factor antibodies. Vitamin B12 supplements were given which led to rapid recovery and normalization of blood parameters.Conclusion. This case highlights the importance and serves as a reminder to clinicians to rule out cobalamin deficiency and autoimmune atrophic gastritis in patients presenting with a picture suggestive of thrombotic thrombocytopenic purpura and pancytopenia, which was completely reversible after appropriate replacement therapy without recurring to unnecessary and invasive procedures such as plasma exchange.

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