Gastric causes of cobalamin malabsorption

(Tables 5.5 and 5.6) Pernicious anaemia Pernicious anaemia (PA) may be defined as a severe lack of intrinsic factor due to gastric atrophy. It is a common disease in north Europeans but it occurs in all countries and ethnic groups. The overall incidence is about 120 per 100 000 population in the UK, but there is wide variation between one area and the next. The prevalence rate in Western countries may be as high as 2-3 . The ratio of incidence in men and women is approximately 1 1.6 and the...

Disorders of basophils and mast cells

High basophil numbers are commonly seen in patients with myeloproliferative disorders, in particular chronic myeloid leukaemia (CML). Basophil number can be strikingly elevated in patients with CML, accounting for over 20 of circulating leucocytes in the more advanced stages of the disease. They are a part of the neoplastic clone expressing the Philadelphia chromosome or the BCR-ABL fusion gene. In other myeloproliferative disorders such as myelofibrosis and polycythaemia vera, elevation of...

Clinical features

Presentation is variable and depends upon the speed with which anaemia develops, the capacity of the bone marrow to compensate and the effects of any associated disease. Most commonly, the onset is insidious, with the gradual awareness of symptoms of anaemia or the observation of pallor or icterus by friends or relatives. Occasionally, the onset is acute, with rapidly developing anaemia and, in older patients, the risk of heart failure. If there is an acute onset with intravascular haemolysis,...

Aetiology

In about one-third of the patients with acquired aplastic anaemia, suspicion may be directed to a particular agent, usually a drug, chemical or virus. Thus, in at least two-thirds of patients, no aetiological agent can be identified (idiopathic aplastic anaemia). The list of drugs recorded as 'causing' aplastic anaemia is long, but mostly only a single or a few cases have been reported for each drug, and it is not profitable to detail them all because the evidence against many of these drugs is...

Monocytes and macrophages Figure i72d and e

The mononuclear phagocyte system has been defined as a family of cells comprising bone marrow progenitors, blood monocytes and tissue macrophages. Monocytes develop from a pluripotent stem cell in the bone marrow, termed colony-forming unit - granulocyte, erythrocyte, monocyte, megakaryocyte (CFU-GEMM) and the more committed CFU-GM. This stem cell can commit to both the neutrophil and monocytic pathways. Cytokines and growth factors, such as monocyte colony-stimulating factor (M-CSF), GM-CSF...

Type 1 haemochromatosis

Inherited as an autosomal recessive trait, this is one of the most common genetic conditions found in populations of northern European origin. In the UK, about one in eight people are carriers of the C282Y mutation of the HFE gene, and about 1 in 200 are homozygous for this mutation. Homozygosity is strongly associated with GH, with about 90 of patients with genetic iron overload having this genotype. Digenetic disease has been described - patients being heterozygous for HFE C282Y and a...

Splenic red cell pool

A similar procedure to that for visualizing the spleen, but with undamaged, labelled red cells, provides a relatively simple method for measuring the splenic red cell volume. By quantitative imaging, the fraction of the administered radionuclide present in the spleen is measured 20-30 min after injection. Normally, the spleen contains 5 or less of the red cell volume about 60 mL , and there is general correlation between splenic red cell volume and the physical size of the spleen. There is a...