Carmel R
Department of Medicine, University of Southern California (USC) School of Medicine, Los Angeles, USA.
Arch Intern Med. 1996 May 27;156(10):1097-100.
Existing information about the prevalence of pernicious anemia is largely based on older surveys that favored florid manifestations, tended to be retrospective analyses of previously diagnosed disease, and usually studied homogeneous European populations. The lack of current data in the United States has, among other things, hampered discussions of the proposal to increase folate intake by the general population.
To estimate the prevalence of undiagnosed and untreated pernicious anemia among the elderly.
A prospective survey of cobalamin levels and anti-intrinsic factor antibody was done in the elderly. Blood testing was done in 729 people aged 60 years or older and follow-up assessment with the Schilling test and other tests was offered when results were abnormal.
Seventeen subjects were found to have pernicious anemia, usually with only minimal clinical manifestations of cobalamin deficiency. Although cobalamin deficiency had been suspected by the physicians of three subjects, they had been treated inadequately and still had evidence of deficiency. Excluding these three partially treated subjects from the analysis, 1.9% of the survey population had unrecognized and untreated pernicious anemia. The prevalence was 2.7% in women and 1.4% in men; 4.3% of the black women and 4.0% of the white women had pernicious anemia.
Undiagnosed pernicious anemia is a common finding in the elderly, especially among black and white women. If these findings can be extrapolated, almost 800000 elderly people in the United States have undiagnosed and untreated pernicious anemia, and, thus, would be at possible risk for masked cobalamin deficiency if exposed to large amounts of folate. This number does not include those elderly with cobalamin deficiency caused by other disorders or the still unknown number of younger people with unrecognized pernicious anemia and other causes of deficiency.
现有的关于恶性贫血患病率的信息很大程度上基于早期的调查，这些调查倾向于明显的表现，往往是对先前诊断疾病的回顾性分析，并且通常研究的是同质性的欧洲人群。美国缺乏当前数据，这在诸多方面阻碍了关于普通人群增加叶酸摄入量提议的讨论。
评估老年人中未诊断和未治疗的恶性贫血的患病率。
对老年人进行了一项关于钴胺素水平和抗内因子抗体的前瞻性调查。对729名60岁及以上的人进行了血液检测，当结果异常时，提供了用希林试验和其他检测进行的随访评估。
发现17名受试者患有恶性贫血，通常仅有钴胺素缺乏的轻微临床表现。尽管有3名受试者的医生怀疑其存在钴胺素缺乏，但他们接受的治疗不充分，仍有缺乏的证据。在分析中排除这3名部分接受治疗的受试者后，调查人群中有1.9%患有未被识别和未治疗的恶性贫血。患病率在女性中为2.7%，在男性中为1.4%；4.3%的黑人女性和4.0%的白人女性患有恶性贫血。
未诊断的恶性贫血在老年人中很常见，尤其是在黑人和白人女性中。如果这些发现可以外推，美国近80万老年人患有未诊断和未治疗的恶性贫血，因此，如果接触大量叶酸，可能有隐匿性钴胺素缺乏的风险。这个数字不包括那些由其他疾病引起钴胺素缺乏的老年人，也不包括仍未知数量的患有未被识别的恶性贫血和其他缺乏原因的年轻人。
