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FLFLOWERGIRL- you mentioned PA, can you tell me what this means and you also mentioned not making IF, can you tell me what that means too. I'm interested regarding my dad's B12. Thanks :)[/QUOTE]

Audrey--:wave:Vitamin B12 is absorbed in the GI tract (in the presence of gastric hydrochloric acid and pepsinogen) when IF, (which is secreted by the parietal cells in the lining of the stomach), binds to B12 in the small intestine where it is absorbed.

Pernicious anemia (PA) is an autoimmune condition of anemia caused by B-12 deficiency. Vitamin B12 deficiency can have many causes, as you know, that also include; PA, malabsorption syndromes, and food cobalmin deficiency. In PA, the autoimmune process that damages parietal cells lining the stomach and/or their proton pumps lead to the disease process. B12 deficiency in PA happens when autoantibodies to (IF) intrinsic factor or parietal cells reduce levels of (IF) intrinsic factor inhibiting absorption of B-12.

PA doesn't necessarily cause anemia, but it leads to anemia when gastritis (gastrointestinal inflammation) and lack of (IF) intrinsic factor prevent intestinal absorption of vitamin B12.

*Tests*-- that you may be interested in for diagnosing PA are; CBC, B12, folic acid level, methylmalonic (MMA) and Homocysteine is also used and can be elevated in PA..

Also, antibody tests for antibodies to IF and parietal cells. The ~blood test~ for MMA is considered superior to the urine testing.

Tests for holo-transcobalamin II (Holo-TC II) are also used to determine the amount of vitamin B12 that is directly available to cells. A low result is an early, sensitive marker of vitamin B12 deficiency. Tests for serum gastrin and pepsinogen are also used to help diagnose PA. In PA, low levels of stomach acid stimulate gastrin production and gastrin levels are elevated. Low total pepsinogen levels or low levels of pepsinogen I compared to pepsinogen II are seen in PA.

[B]Antibodies to IF may be either binding /or blocking antibodies:[/B]
*Binding* antibodies bind to the IF binding site and interfere with the absorption of intrinsic factor.

*Blocking* antibodies bind to the receptor of cells in the ileum preventing intrinsic factor absorption.

Only some patients with PA have IF antibodies, while all patients with IF antibodies have PA. These antibodies, have a greater specificity for PA. More patients with PA have parietal cell antibodies, but these antibodies are seen in other autoimmune conditions as well such as atrophic gastritis. Antibodies to intrinsic factor are considered superior for diagnosing PA.

PA and atrophic gastritis are the two most common autoimmune disorders to develop in patients with Graves' disease, especially in patients with ongoing immune stimulation, including Graves' disease patients who have had radioiodine ablation.

Your father should have these test with a low B-12, but I can't remember off hand how low he was. Perhaps we should start a new thread on this. Be Well. FLFLOWERGIRL:)

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