The full content of Annals is available to subscribers

Subscribe/Learn More  >
Case Reports |

Pernicious Anemia and Immunologic Deficiency

Ann Intern Med. 1968;68(3):603-612. doi:10.7326/0003-4819-68-3-603
Text Size: A A A

The association of pernicious anemia with immunologic deficiency has previously been described in 16 patients. Two additional cases are presented in this report. The suggestion that serum gamma globulin levels are commonly reduced in patients with pernicious anemia was not confirmed by immunoquantitation of serum immunoglobulins in 18 patients with pernicious anemia in relapse. Quantitation of immunoglobulins in 10 patients with malabsorptive disorders of diverse cause did not show any instances of true hypogammaglobulinemia. Four of these patients exhibited increased serum immunoglobulin A levels, a phenomenon previously reported only in gluten enteropathy.

Although the anemia in these hypogammaglobulinemic patients was characteristic of pernicious anemia by hematologic and gastric criteria, it was unusual in several ways. First, the average age of the patients at onset of the anemia was 30 years, unusually early for pernicious anemia. Second, none had parietal cell or intrinsic factor antibodies. Third, Giardia lamblia was reported in half the patients with this combination of diseases.

The concurrence of pernicious anemia and hypogammaglobulinemia is too frequent to be explained by coincidence. Although the explanation of this relationship is not clear, the associations of hypogammaglobulinemia with malabsorption and of malabsorption with gastric atrophy suggest that gastric atrophy may be a secondary consequence of hypogammaglobulinemia which usually precedes the pernicious anemia. Further investigations are needed to clarify the pathogenesis of this fascinating syndrome.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
[Hemolytic anemias and vitamin B12 deficieny]. Dtsch Med Wochenschr 2015;140(17):1302-10; quiz 1311-2.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.