Case 1: an update

Remember the young woman with severe B12 deficiency? I saw her again yesterday; she's doing really well. Her haemoglobin is up to 9.6 g/dl (up, on B12 supplements alone, from about 4), the rest of her full blood count has normalised, and she tells me she's eating like a horse! (No doubt this is the increased caloric demand from her body's cells suddenly being able to divide properly again, plus the absence of the nausea that had contributed to her weight loss.)

Her anti-parietal cell antibodies have come back negative, and the anti-intrinsic factor ones are unaccountably still not back yet, which doesn't exactly help us in terms of confirming pernicious anaemia (although they aren't always positive in this condition either). We've decided to do another gastroscopy with a view to getting a biopsy of the stomach, which should settle the matter. We've also done a brief screen for concomitant disorders of other endocrine glands (e.g. thyroid, adrenal cortex), which can be simultaneously dysfunctional in certain cases of pernicious anaemia.

UPDATE 02/05/09

Her anti-intrinsic factor antibody assay has come back positive, which helps point towards our original diagnosis of pernicious anaemia.