intrinsic-factor and Postoperative-Complications

Combined medullary sclerosis developed suddenly postoperatively in a patient with unknown Biermer's disease. The neurological lesions were undoubtedly induced by nitrogen protoxide via an inactivation of vitamin B12.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Abscess; Aged; Anemia, Pernicious; Anesthetics, Inhalation; Arthroplasty, Replacement, Hip; Atrophy; Autoantibodies; Autoimmune Diseases; Demyelinating Diseases; Female; Gastric Mucosa; Humans; Intestinal Absorption; Intrinsic Factor; Nitrous Oxide; Oxidation-Reduction; Paresthesia; Postoperative Complications; Proprioception; S-Adenosylmethionine; Sclerosis; Spinal Cord; Spinal Cord Diseases; Surgical Wound Infection; Vitamin B 12

A case of 78-year old man with megaloblastic anemia occurring 20 years after partial gastrectomy is reported. Since about 2 years earlier he had an episode of convulsion, and he had been on anti-convulsants (diphenylhydantion, phenobarbital) until admission. Physical examination revealed a pale lean man with polyneuropathy and mental impairment. Laboratory findings revealed WBC 3100/microliters, RBC 187 X 10(4)/microliters, HB 7.9 g/dl, MCV 124.4 microns3, MCH 42.7 micrograms, platelet counts 15.7 X 10(4)/microliters, serum vitamin B12 (VB12) 380 pg/ml, and serum folic acid 5.1 ng/ml. Serum autoantibodies to intrinsic factor (IF) and parietal cells were positive. Bone marrow examination revealed erythroid hyperplasia and megaloblastic changes. Schilling test revealed impaired absorption of VB12 with or without IF, but X-ray study of the small bowels was unremarkable. Treatment with intramuscular cyanocobalamin resulted in a rapid clinical improvement. A repeat Schilling test after 4 months of therapy showed a normal VB12 absorption in the presence of IF. These findings suggest that VB12 malabsorption of the 1st Schilling test was due to intestinal dysfunction caused by the VB12 deficiency state itself, and the improvement of VB12 absorption with IF after therapy suggests a pathogenesis similar to pernicious anemia in this patient.

Topics: Aged; Anemia, Macrocytic; Anemia, Megaloblastic; Autoantibodies; Gastrectomy; Humans; Intrinsic Factor; Male; Postoperative Complications; Schilling Test; Vitamin B 12

A middle-aged woman developed a postgastric bypass megaloblastic anemia which responded to treatment. She eventually had the bypass reversed 6 1/2 yr after it had been performed. Gastric parietal cell function has remained abnormal almost 3 yr after reversal of the bypass, as demonstrated by abnormal Schilling tests and high serum gastrin levels. Parietal cell antibodies in high titer, but no intrinsic factor antibodies, were demonstrated in her blood. These observations are interpreted as indicating the development of irreversible chronic atrophic gastritis probably related to reflux of bile into the bypassed stomach.

Topics: Adult; Anemia, Megaloblastic; Female; Gastric Acid; Gastrins; Humans; Intrinsic Factor; Parietal Cells, Gastric; Postoperative Complications; Stomach; Vitamin B 12 Deficiency

Recent studies of the role of platelets in blood coagulation have shown that platelets can trigger intrinsic coagulation by two alternative pathways, protect platelet-associated active clotting factors from inactivation by plasma inhibitors and catalyze intrinsic coagulation reactions on the platelet surface to form fibrin. These platelet coagulant activities (i.e., contact product forming activity, collagen-induced coagulant activity, intrinsic factor Xa forming activity and platelet factor 3 activity) were found to be increased in patients with deep vein thrombosis developing after hip surgery, in patients with established retinal vein thrombosis and in patients with established deep vein thrombosis. It is suggested that increases in platelet coagulant activities concerned with triggering and catalyzing intrinsic coagulation reactions may play a role in the pathogenesis of venous thrombosis.

Topics: Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelets; Collagen; Enzyme Activation; Factor X; Hip; Humans; Intrinsic Factor; Platelet Adhesiveness; Platelet Factor 3; Postoperative Complications; Recurrence; Retinal Vein; Thrombophlebitis

Topics: Achlorhydria; Atrophy; Autoantibodies; Biopsy; Duodenal Ulcer; Duodenum; Follow-Up Studies; Gastrectomy; Gastric Mucosa; Gastritis; Humans; Intrinsic Factor; Iron; Postoperative Complications; Stomach

Topics: Adult; Age Factors; Aged; Alcohol Drinking; Duodenal Ulcer; Erythrocytes; Follow-Up Studies; Gastrectomy; Gastric Juice; Humans; Intrinsic Factor; Leiomyoma; Methods; Middle Aged; Pepsin A; Postoperative Complications; Schilling Test; Stomach Neoplasms; Stomach Ulcer; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Pernicious; Animals; Chromatography, Gel; Chromatography, Ion Exchange; Chromium Isotopes; Electrophoresis; Feces; Gastrectomy; Gastric Juice; Gastritis; Guinea Pigs; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Intestinal Mucosa; Intrinsic Factor; Liver; Postoperative Complications; Swine; Vitamin B 12