Pernicious anaemia treatment

Cyanocobalamin (vitamin B12) Propionibacterium freudenreichii Propionibacterium shermanii Pseudomonas denitriTicans Treatment of pernicious anaemia... 

Most importantly, the determination of cortisol levels is considered useful in the diagnosis and treatment of various ailments, namely Addison s Disease i.e., pernicious anaemia—a condition whereby the maturation of the red cells may not proceed beyond the stage of megaloblasts Cushing s Syndrome. 

Vitamin B12 Vitamin B12 is an important cobalt complex. The vitamin was isolated from liver after it was found that eating large quantities of raw liver was an effective treatment for pernicious anaemia. The term vitamin B12, refers to cyanocobalamin. Vitamin B12 is a coenzyme, and serves as a... 

Treatment of pernicious anaemia has traditionally involved the parenteral delivery of vitamin B12 to ensure absorption. Oral replacement is now an accepted route, using large doses of vitamin B12, 1-2mg daily. 

Schwartz, M., Lous, P., and Meulengracht, E., Reduced effect of heterologous intrinsic factor after prolonged oral treatment in pernicious anaemia. Lancet i, 751-753 (1957). 

Early treatment of severe pernicious anaemia with hydroxocobalamin, as the iron stores occasionally become exhausted by the surge in red cell formation. 

Deficiency of folic acid leads to a megaloblastic anaemia because it is necessary for the production of purines and pyrimidines, which are essential precursors of deoxyribonucleic acid (DNA). The megaloblastic marrow of cobalamin deficiency is due to interference with folic acid utilisation and the morphological changes of cobalamin deficiency can be reversed by folic acid. It is vital to realise that folic acid does not provide adequate treatment for pernicious anaemia. Nor does vitamin 3 2 provide adequate treatment for the megaloblastic anaemia of folic acid deficiency, although a partial response may occur because vitamin plays a role in folate metabolism. 

Castle W B 1966 Treatment of pernicious anaemia historical aspects. Clinical Pharmacology and Therapeutics 7 347... 

Klemetti L. Is the vitamin B12 treatment of pernicious anaemia a predisposing factor for thrombosis in aged patients Acta Med Scand 1964 176 121-2. 

Measuring the serum vitamin B j concentration is inappropriate in patients on parenteral treatment. A routine blood count is much more appropriate. In a patient with pernicious anaemia feeling run down , hypothyroidism should also be suspected and thyroid function assessed. The incidence of carcinoma of the stomach is increased among patients with pernicious anaemia and this diagnosis should also be borne in mind. 

Ten out of 22 patients receiving iron dextran for iron-deficiency anaemia and also given chloramphenicol, failed to show the expected haematological response to the iron. Four patients receiving vitamin B]2 for pernicious anaemia were all similarly lefiactory to treatment until the chloramphenicol was withdrawn. ... 

Orotic acid at high doses (3-6 g per day) was used with moderate success in adult patients with pernicious anaemia [444]. Kelley and co-workers [445] investigated the use of orotic acid in the treatment of hyperuricaemia. There was a 20-30% inhibition of purine biosynthesis and an increase in renal clearance of uric acid, but orotic acid offered no advantages over other available agents. Orotic acid in combination with vitamin was used in children with disturbed memory [446], and in combination with Kanaform in patients with cerebral trauma and vascular affections [447]. 

Wills, L., 1931. Treatment of pernicious anaemia of pregnancy and tropical anaemia. British Medical Journal. 1 1059-1064. 

About 70% of patients also have anti-intrinsic factor antibodies in plasma, saliva and gastric juice. Although the oral administration of partially purified preparations of intrinsic factor will restore the absorption of vitamin B in many patients with pernicious anaemia, this can result eventually in the production of anti-intrinsic factor antibodies, so parenteral administration of vitamin B is the preferred means of treatment. For patients who secrete anti-intrinsic factor antibodies in the saliva or gastric juice, oral intrinsic factor will be useless. 

Hypergastrinaemia in humans is excessive in pernicious anaemia and moderate after vagotomy and during treatment with H2-receptor-block-ing agents and PPIs. The gastrin levels usually correspond with the reduction of gastric secretion. 

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