PN/B12 Def Is it Pernicious Anemia? Schilling Results

[deejay]

Hi All
Anybody know how to interpret Schilling results? One doctor says I do have pernicious anemia, but another says I don't. Wondering if anybody may have similar results.
In a nutshell:

B-12 @ 112 two years ago

mega injections (and tab's as recommended by Rose here) later, B-12 only slightly improved....only once as high as 500....usually around 300

Had Schilling test...Results: 11.5% (I think to be abnormal is less than 10%)

Also had Methylmalonic Acid just recently...High @ 397

PS. Celiac Ruled Out

So, Are Schilling Test results pretty cut and dry at 10%? Is 11.5% definitely normal? Like with B-12....even in the "normal range" low can still be abnormal.

Thanks.

[rose]

The Schilling test is not often used anymore. Better tests have been available for a long time. However there are some situations in which it might be helpful.

First, if you have had the Schilling test, you need to know whether they bound the B12 in protein. A normal result can be had if a person cannot absorb from food but can absorb small doses of crystaline B12 (B12 not in food). If you cannot absorb well from food, you may still have intrinsic factor but be in the process of losing it.

It is likely that your doctors are using either the wrong definition or two different definitions for "pernicious anemia." One may be referring to lack of intrinsic factor (correct), while the other may still think that "pernicious anemia" is a type of anemia (incorrect).

The accepted way to diagnose pernicious anemia has for years now been to test for antibodies to parietal cells and intrinsic factor. In most cases, when intrinsic factor is lacking, one of those will be positive. A small percentage of pernicious anemia cases are missed with even those tests.

What dose and type of tablets have you been taking?

Have you had the health of your liver and kidneys explored carefully? Kidney problems should be especially suspect with a high methylmalonic acid in spite of all that B12.

rose

[deejay]

Thanks Rose...You are so knowledgeable!

I forgot to mention the most important thing leading to the initial diagnosis of PA. I did test positive for Antiparietal Cell Antibodies...level was High!

The two doctors are both Hematologists, so I'm sure they don't misunderstand the anemia part of it...hopefully.

Think kidney function tests have been ok...there's one that looks strange to me, but the doc who ordered it never commented on the results. Know anything about Renin? Results flagged as being Double Checked, but hard to interpret what normal really is.

So...with new info,
Positive Antiparietal Cell Antibodies
High MMA
Schilling 11.5%

I'm still confused....Could it still be PA? The second hematologist says, I don't think you have PA, based on the Schilling.

[deejay]

One more thing...looking at Schilling Results to see if bound to protein. Not sure. Maybe you can tell.

It reads:
Pt given 0.5 uCi Cobalt-57 labeled B12 orally, with IM loading dose of 1000 mcg non-labeled B12. 24 HR Urine collected and assayed for radiolabeled B12. Showed an excretion of 11.5% of the administered activity.
Schilling Test Part One Normal.

[rose]

Hematologists are supposed to be the "go-to" specialty in difficult cases, BUT over and over I have seen records showing that many of them are incredibly ignorant.

It looks like you have had the one with B12 not bound by protein. That would generally be the first step. The test indicates that you have not yet lost the ability to produce intrinsic factor. HOWEVER, the evidence is VERY strong that your stomach lining (gastric lining) is atrophying because your ammune system is attacking it. And that would mean that it is likely that the 2nd step in the Schilling test would show that you don't obtain B12 normally from food. But you don't need the 2nd step, because you already know you have the antibodies.

Atrophy of the stomach lining may or may not progress from malabsorption from food to the severe malabsorption of pernicious anemia. But what you have is the most common cause (atrophy of the stomach--gastric--lining) of pernicious anemia (loss of intrinsic factor and resulting severe malabsorption).

If I were you, I would take the advice of Goldman: Cecil medical textbook and treat myself as though pernicious anemia exists, because you may progress to it.

rose
http://roseannster.googlepages.com/home