Research & Initiatives

Several scientific articles and textbooks have described the clinical presentation of patients with cobalamin (vitamin B12) deficiency. After the classic presentation of Addison-Biermer disease with megaloblastic anemia and muscle loss, many generations of doctors have been educated with the view that vitamin B12 deficiency exclusively presents itself with low levels of drug metabolism. Additional cases have been reported in which neurologic abnormalities were the main presenting symptom, with subacute combined degeneration of the spinal cord as one of the most feared manifestations, often leading to permanent disability. Lindenbaum et al reported a large series of 40 patients who had experienced reduced levels of drug absorption and metabolism caused by vitamin B12 deficiency but who had no anemia or macrocytosis.
 

Biomarker response after supplementation with oral and intramuscular vitamin B12 will be compared in a randomized clinical trial. Electronic compliance monitoring will be used to control for noncompliance as a possible confounder in oral treatment. Additionally, subjective acceptance in terms of presumed preferences will be compared with oral vs. intramuscular supplementation of vitamin B12 in the view of the patient.

IT has adequately demonstrated that the basic defect in pernicious anemia is the failure of the mucosal cells in the fundal portion of the stomach to secrete intrinsic-factor substance. This factor is necessary for the normal absorption of vitamin B12 from the small intestine. A few reports in the literature have shown suboptimal reticulocyte responses in patients with pernicious anemia in relapse receiving ACTH and cortisone.1 2 3 4 We have recently studied the effect of adrenocortical-steroid administration on the absorption of radioactive vitamin B12 in classic primary pernicious anemia utilizing the Schilling test, which measures the absorption of orally administered radioactive