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Pathophysiology and laboratory diagnosis of pernicious anemia

  • Mechanism in Autoimmunity
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Abstract

Pernicious anemia is the hematologic manifestation of chronic atrophic gastritis affecting the corpus of the stomach that denudes the gastric mucosa of gastric parietal cells. Asymptomatic autoimmune gastritis, a chronic inflammatory disease of the gastric mucosa, precedes the onset of corpus atrophy by 10–20 years. The gastritis arises from activation of pathologic Th1 CD4 T cells to gastric H/K ATPase that is normally resident on gastric mucosal secretory membranes. The onset of autoimmune gastritis is marked by circulating parietal cell antibody to gastric H/K ATPase. Gastric parietal cells produce two essential biologics: intrinsic factor and HCl acid. Pernicious anemia is a consequence of intrinsic factor loss and neutralizing intrinsic factor antibody that impairs cobalamin absorption. Acid loss leads to iron deficiency anemia that precedes cobalamin-deficient pernicious anemia by 20 years. Laboratory diagnosis rests on parietal cell antibody with or without intrinsic factor antibody, cobalamin-deficient megaloblastic anemia and elevated serum gastrin from loss of acid secretion. Autoimmune gastritis is associated with autoimmune thyroiditis and type 1 diabetes mellitus.

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Authors and Affiliations

  1. Department of Medicine, Southern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, and Australian Clinicalabs, Clayton, VIC, Australia

    Ban-Hock Toh

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  1. Ban-Hock Toh
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Correspondence to Ban-Hock Toh.

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Toh, BH. Pathophysiology and laboratory diagnosis of pernicious anemia. Immunol Res 65, 326–330 (2017). https://doi.org/10.1007/s12026-016-8841-7

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  • DOI: https://doi.org/10.1007/s12026-016-8841-7

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