Pernicious anemia

[gaylemh]

I hope you can answer some questions I have.

I was tested for Pernicious anemia 7/03.  The test results were.
B12 Serum  267 (200-1100)  Parietal Cell AB W/Ref AB Screen Positive - Parietal Cell Titer 1:20 H (less than 1:20) Methylmalonic Acid Serum 150 (90-279) Homocysteine 10.7 H (less than 10.4)  Intrinsic Factor Block AB negative.

The doctor could not confirm a positive diagnosis for Pernicious anemia but said it could be.  Started me on B12 Shots weekly for a few weeks and then once a month for a few months.  B12 in 10/03 went up to 1234.   Doctor said I didn't need shots anymore.

B12 test 5 months later in March dropped to 495.  Doctor still said normal.

I have been feeling very fatigued with tiredness in my legs and arms.  I have also been having an internal tingling that I feel mostly in my legs but at times feel it in my whole body, including my lower face and mouth.  It dosen't get numb, but is a continuous mild tingling that never goes away.

I have tested positive for Hashi's and have been on synthroid for the past two years.  

I have also been diagnosed with Crohn's when I was 24 (I am now 52) I have been very lucky as I had only two flares when I was in my 20s. I have had recent test done upper lower and small bowel a few months ago and everything was normal.

My question is do you think I could have Pericious anemia that could be causing my symptoms?  What does the positive Parietal antibodies mean, and is it normal for the B12 level to drop 700 points in 5 months?  Have no idea what the level is now as the last test was 7 months ago.

I have an appointment with the doctor on Monday and I want to know what kind of tests I should be asking for to find out what could be causing the internal tingling.

Thanks
Gail

[Kevin Pho, MD]

Antibodies to parietal cells may be suggestive of pernicious anemia, however it is not the most accurate test.  It suffers from a relatively low specificity - meaning that a positive test may not be caused by pernicious anemia.  

The test for antibodies for intrinsic factor would be more helpful - but is not the most perfect test.  If positive, then it is highly suggestive of pernicious anemia, but the sensitivity ranges from 50 to 80 percent (i.e. will be positive only 50 to 80 percent of the time when pernicious anemia is present).

Another consideration would be to perform the Schilling test, where administration of radionucleotides can help with the diagnosis.  

Regarding the B12 levels - there will be times where the levels will vary.  The amount of variation would depend if there is disease present or not.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[NICK_ROGERS]

Hi gaylemh, this internal tingling has been experienced by me, it happens when my stomach is acting up.  I have been told that the tingling in the muscles throughout the body is common when their are stomach problems...

[gaylemh]

Hi!

Thanks for your reply.  What kind of stomach problems do you have?  

Gail

[Biskie2]

Have you had your large intestine checked? I had my terminal ilium out (resectionby way of Crohn's) about 25 years ago and have pernicious anemia - have been on B-12 shots monthly since, and monitored every two months.

[gaylemh]

Hi!  Yes I just had an upper and lower endoscopy done a few months ago.  Also had a small bowel series done.  Everything normal except for some gastritis.  I have been very lucky, I have only had two flares when I was in my twenties.