Htut Thura W, Thein Kyaw Z, Oo Thein H
Department of Haematology, Aberdeen Royal Infirmary, University of Aberdeen, NHS Grampian, Aberdeen, UK.
Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA.
J Community Hosp Intern Med Perspect. 2025 Jan 6;15(1):22-29. doi: 10.55729/2000-9666.1437. eCollection 2025.
Cobalamin deficiency (CD) due to pernicious anemia (PA) leads to hyperhomocystinemia, a risk factor for thrombosis. However, the clinical presentations and outcomes of hyperhomocystinemia-associated thrombosis (HAT) are not fully understood.
We undertook a literature search using PUBMED, SCOPUS and WEB OF SCIENCE databases for the terms "pernicious anemia AND thrombosis", "pernicious anemia AND embolism", "pernicious anemia AND thromboembolism", "autoimmune gastritis AND thrombosis", "autoimmune gastritis AND embolism", "autoimmune gastritis AND thromboembolism" through January 2024 and reviewed the published literature. Our aim was to illustrate the clinical features of PA-related HAT.
Of 20 patients, the median age was 54.5 years (60 % males). 35 % of patients were elderly. The median serum homocysteine level was 67.75 umol/L. 35 % of patients developed thromboses at multiple locations while 20 % had thromboses at unusual sites. 45 % of patients had co-existing neuropsychiatric symptoms. 80 % of patients were positive for anti-IF (anti-intrinsic factor) antibodies. All patients received cobalamin replacement and the median duration of antithrombotic therapy was 6.5 months for reported cases. None developed recurrent thromboembolism.
This rare condition is associated with high incidence of thromboses at unusual sites, multiple-site thromboses, co-existing neuropsychiatric symptoms, high positivity rate for anti-IF antibodies and low recurrent thrombosis rate.
由于恶性贫血（PA）导致的钴胺素缺乏（CD）会引发高同型半胱氨酸血症，这是血栓形成的一个风险因素。然而，高同型半胱氨酸血症相关血栓形成（HAT）的临床表现和结局尚未完全明确。
我们使用PUBMED、SCOPUS和科学网数据库，通过检索截至2024年1月的“恶性贫血与血栓形成”“恶性贫血与栓塞”“恶性贫血与血栓栓塞”“自身免疫性胃炎与血栓形成”“自身免疫性胃炎与栓塞”“自身免疫性胃炎与血栓栓塞”等词条，对已发表的文献进行了回顾。我们的目的是阐述与PA相关的HAT的临床特征。
在20例患者中，中位年龄为54.5岁（男性占60%）。35%的患者为老年人。血清同型半胱氨酸中位水平为67.75μmol/L。35%的患者在多个部位发生血栓形成，而20%的患者在不寻常部位发生血栓形成。45%的患者伴有神经精神症状。80%的患者抗内因子（anti-IF）抗体呈阳性。所有患者均接受了钴胺素替代治疗，报告病例的抗血栓治疗中位持续时间为6.5个月。无一例发生复发性血栓栓塞。
这种罕见疾病与不寻常部位血栓形成、多部位血栓形成的高发生率、并存的神经精神症状、抗IF抗体的高阳性率以及低复发性血栓形成率相关。
