Strange definition of pernicious anemia

[palmier]

Found this questionable definition of pernicious anemia on a Johns Hopkins web page about gastritis:

Pernicious anemia. This is a form of anemia that happens when your stomach can't digest vitamin B-12.

Even the best seem to get it wrong.

hopkinsmedicine.org/health/...

[Technoid]

Yes, if the definition of digestion is accepted as

"Digestion is the process of mechanically and enzymatically breaking down food into substances for absorption into the bloodstream."

then digestion is something that happens to food, not to B12. It is possible to talk about the digestion of animal foods to absorb B12 as the B12 is bound to a protein and this must be broken to begin the B12 absorption process but this is not a necessary step in supplemented or fortifed food.

In PA, reduced stomach acid from the reduction or elimination of parietal cells will impact the digestion of animal foods and thus the availability of B12 for absorption if most of the B12 in the diet is from animal foods.

But obviously the point is that PA (I hate this name 😆) should really be defined in autoimmune terms. The effect on digestion of animal foods is relevant but the impact on intrinsic factor and the absorption of B12 IN ANY FORM, is really key.

Johns Hopkins should certainly know better!

[Orchard33]

A very mediocre article. It's significant that PPIs are not included as a cause of B12D. American doctoring is BigPharma orientated, even more than here.

[Cherylclaire Forum Support]

You might find this interesting, palmier.

In the library, doing a desperate search of the shelves, I found a copy of Wheeler and Jack's Handbook of Medicine (9th Ed. Jan 1932) and looked up Pernicious Anaemia:

"A progressive and profound anaemia developing without any evident cause, characterised by great diminution in the number of the red corpuscles and hyperplasia of the bone-marrow. Etiology.- The essential cause is not yet definitely known. It occurs in males more than females (proportion about two to one), and usually between the ages of twenty-five to forty years. It occurs in all countries and in all classes, is not occupational, and there is no familial or hereditary factor....."

William Hunter is quoted here (Observations on the treatment of pernicious anaemia based on a study of its causation: with notes of a case. Pub 1890) :

"...Its chief characteristic is a marked haemolysis, which is probably dependent on a toxaemic condition, believed by William Hunter to be due to bacterial toxins derived from oral sepsis. This, in his opinion, sets up a specific glossitis and gastro-enteritis, and the organism would therefore be of the haemolytic streptococcus class, but no such organism has yet been isolated in this disease....."

Hurst is quoted as finding achlorhydria ("practically a constant feature") causative.

Gulland is quoted as believing it to be "an affection of the bone-marrow set up by a toxin of undetermined origin".

And "of recent years" the successful treatment using liver "...on the lines suggested by Minot and Murphy has focussed attention to the liver as the seat of a definite deficiency. By experiment it has been established that the active fraction of the liver is non-protein and soluble in water, but not in cold alcohol or in ether..... " and this investigation was ongoing: "....and so far the effect has not been traced to any known vitamin."

The entry continues with sections on Morbid Anatomy, Symptoms, Prognosis and Treatment.

Re treatment: "Formerly it was accepted that arsenic was the chief remedy, iron being of little use ; and it was recognised that, to obtain results, arsenic must often be pushed to the limits of tolerance."

[Suddenly, raw liver as treatment is sounding way more attractive.]

Liver used as treatment has been reported to be effective "in most cases", but "Where there is an associated postero-lateral sclerosis present, however, opinions are divided as to the specific improvement in the nervous symptoms." Septic teeth and mouth conditions should be addressed.

Achlorydria should be "suitably corrected by the use of pepsin and dilute hydrochloric acid in sufficient dosage.." while arsenic, thankfully, is deemed "unnecessary"!

[Technoid in reply to Cherylclaire]

Arsenic, yikes 🤣

[Cherylclaire Forum Support in reply to Technoid]

>gulp<

[Technoid in reply to Cherylclaire]

The patient was cured of their pernicious anemia. This is due to the fact that the patient is no longer alive. We consider this a success.

[Cherylclaire Forum Support in reply to Technoid]

"To obtain results, arsenic must be pushed to the limits of tolerance" : a huge element of patient-doctor trust involved !

By the way, Hunter proposed the name "glossitic anaemia" for the disease. Any takers ?