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Oral Cobalamin for Treatment of Pernicious Anemia?

John N. Hathcock, PhD; Gloria J. Troendle, MD
JAMA. 1991;265(1):96-97. doi:10.1001/jama.1991.03460010096040.
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Pernicious anemia is a cobalamin deficiency disease caused by a lack of intrinsic factor (IF), which is necessary for the absorption of this vitamin. Because of the extensive hepatic storage of cobalamin, primary dietary deficiency is uncommon, occurring only in strict vegetarians after avoidance of animal products for many months. The most common cause of IF deficiency is gastric atrophy. Total gastrectomy leads to pernicious anemia, and partial gastrectomy does so occasionally. A rare congenital form of pernicious anemia may be the result of an autosomal recessive failure in IF production. It is possible to treat pernicious anemia with oral IF. This was standard practice at one time, but has lost favor because of the difficulty and expense of obtaining IF. For the last 30 or more years, the usual treatment has been 1000 μg of cobalamin administered intramuscularly once every 1 to 3 months. With a retention efficiency of


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