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Coexistence of Pernicious Anaemia and Chronic Myeloid Leukaemia: An Experiment of Nature Involving Vitamin B 12 Metabolism
Author(s) -
Corcino J. J.,
Zalusky R.,
Greenberg M.,
Herbert V.
Publication year - 1971
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1971.tb07066.x
Subject(s) - vitamin , pernicious anaemia , medicine , vitamin b , endocrinology , chronic myeloid leukaemia , pernicious anemia , anemia
S ummary . Chronic myeloid leukaemia (CML) and pernicious anaemia (PA) coexisted in a 51‐yr‐old man (who also had myasthenia gravis). His serum vitamin B 12 level was normal instead of the high value expected in CML, or the low value expected in PA. Short‐term culture of his peripheral blood cells showed deranged DNA synthesis of the type observed in vitamin B 12 deficiency, indicating that his ‘normal’ serum vitamin B 12 level was not associated with normal amounts of vitamin B 12 available to his CML cells. A tracer dose of 0.45 μg of[ 57 Co]vitamin B 12 disappeared abnormally slowly from his serum over 24 hr (as previously observed by others in patients with either CML or PA). A therapeutic injection of vitamin B 12 appeared to disappear abnormally slowly from his serum over a period of 2 yr. His serum showed a markedly elevated unsaturated vitamin B 12 binding capacity, with a less sharp increase in percentage of vitamin B 12 binding α as compared to β globulin than usually expected in CML. Withholding therapeutic vitamin B 12 for 2 yr has been associated with stabilization of his WBC at the 40 000‐50 ooo/μl range. Although this association could be chance rather than cause and effect, the patient does represent an ‘experiment of nature’ involving vitamin B 12 metabolism and does raise the question as to whether his leukaemia is retarded by his deficiency of vitamin B 12 , which results from inadequate absorption of vitamin B 12 and possibly from elevated serum vitamin B 12 binding a globulin rendering his circulating vitamin B 12 metabolically inert.