Vitamin B12 deficiency is usually due to dietary factors, however clinicians always consider the possibility of autoimmune pernicious anaemia. The Schillings test is no longer routinely available and therefore diagnosis often includes the specific intrinsic factor auto-antibodies (IFAb) +/– parietal cell auto-antibodies (PCAb). Holo-transcobalamin (HoloTC), also known as active B12, has proved to be a more reliable indicator of B12 deficiency than measuring total B12 (TB12). We therefore reviewed our experience with this test to see if HoloTC was more closely associated with pernicious anaemia testing.Pernicious anemia is commonly associated with autoimmune disorders. This abstract will describe three cases with low serum Vitamin B12 even with 2 weeks Vitamin B12 inrtamuscular injection of 1000 micrograms. First patient is thirty nine 39 years old white male with known history of pernicious anemia and Alopecia Totalis with prior history of Methotrexate and cyclosporin treatment. The patient had low serum iron and low iron saturation at initial presentation. He was given IV Iron supplement to saturate iron stores with good result. However, his serum vitamin B12 remain border line low normal below 300 pg/ml ( patient's level is 210, normal range 180-941 pg/ml), even with every two weeks IM injection for more than six months. Patient was also given oral supplement with no increase in the serum vitamin B12 level. The second patient is sixty eight 68 years old white female with history of colon cancer that underwent resection and history of Hashimoto's Thyroiditis who was on Thyroid hormonal supplement. Her serum Vitamin B12 level remain borderline low below 300. The third patient is forty 40 years old white female with history of Hypothyroidism and breast cancer that had received adjuvant chemotherapy post Lumpectoy and radiation therapy.

This patient was treated with IV intravenous iron supplement for iron deficency with good result. All three patients had blocking antibodies to intrinsic factor and presented with various degree of iron deficency and treated with oral as well as IV iron supplement. Peripheral blood smear were reviewed on all the three patients. Hypersegmentation of neutrophils was seen with normocytic normochromic red cell morphology. One patient had low plateletes count. All patients had white blood cell counts below ten thousands. Two patients showed excess of apoptotic neutrophils. None of the patients had enlarged spleen or adenopathy or evidence of bone marrow hypofunction. All of the above patients improved clinically interm of sense of well being and increased level of energy with vitamin B12 supplement. None of the above patients had abnormal liver or kidney function. All patients had low serum vitamin B12 with one monthly dose IM injection plus oral supplement. All patients had normal LDH level and normal Folic acid level.

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Mishita
Jornal co-ordinator
Journal of  Autoimmune Disorders