Megaloblastic pernicious anemia is an autoimmune disorder, considered rare in African context. The objective of this study was to report four clinical cases collected at the CHUR/OHG, and to review the literature. The study population consisted of two men and two women. The clinical manifestations were mainly neurological and hematological. The neurological signs were mainly paresthesia. One patient presented memory problems. On the biological level, macrocytic anemia and vitamin B12 deficiency were reported in two cases prior to treatment while the other two without serological assay of vitamin B12 were put on trial treatment. Anti-intrinsic factor antibodies were positive in three patients. The Schilling test was not used. Upper gastrointestinal endoscopy revealed atrophic fundic gastritis in all four patients who received treatment through intramuscular injection of hydroxocobalamin (vitamin B12). The evolution was favorable after one month of treatment in all cases. The literature review is dominated by clinical case reports, the largest cohorts of which are from the Maghreb.
KeywordsAnemiaPerniciousMegaloblasticVitamin B12
Rojas Hernandez, C.M. and Oo, T.H. (2015) Advances in Mechanisms, Diagnosis, and Treatment of Pernicious Anemia. Discovery Medicine , 19, 159‑168.
Morawiec-Szymonik, E., Foltyn, W., Marek, B., Głogowska-Szeląg, J., Kos-Kudła, B. and Kajdaniuk, D. (2020) Antibodies Involved in the Development of Pernicious Anemia and Other Autoimmune Diseases. Polish Archives of Internal Medicine , 130, 31‑37.
Vaqar, S. and Shackelford, K.B. (2024) Pernicious Anemia. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK540989/
Rodríguez de Santiago, E., Ferre Aracil, C., García García de Paredes, A. and Moreira Vicente, V.F. (2015) Pernicious Anemia. from Past to Present. Revista Clínica Española , 215, 276-284. https://doi.org/10.1016/j.rceng.2015.03.001
Oo, T.H. (2019) Diagnostic Difficulties in Pernicious Anemia. Discovery Medicine , 28, 247‑253.
Trivedi, M., Areti, A., Venishetty, N., Parikh, A. and Didia, C. (2024) Pernicious Anemia Unveiled: Unusual Hemolytic Complications and Clinical Implications. Cureus , 16, e57901. https://doi.org/10.7759/cureus.57901
Tun, A.M., Thein, K.Z., Myint, Z.W. and Oo, T.H. (2017) Pernicious Anemia: Fundamental and Practical Aspects in Diagnosis. Cardiovascular & Hematological Agents in Medicinal Chemistry , 15, 17-22. https://doi.org/10.2174/1871525715666170203114632
Coulibaly, A., Somda, S.K., Koura, M., Napon, C., Sombié, A.R., Sermé, A.K., et al . (2016) Maladie de Biermer : Etude de quatre cas au Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou. Sci ence et Tech nique , Sci ences de la Santé , 39, 99‑106.
Castellana, C., Eusebi, L.H., Dajti, E., Iascone, V., Vestito, A., Fusaroli, P., et al . (2024) Autoimmune Atrophic Gastritis: A Clinical Review. Cancers , 16, Article 1310. https://doi.org/10.3390/cancers16071310
Derrien, J.P., Varieras, G., Gaultier, Y. and Thomas, J. (1978) Biermer’s Disease in Senegal. Bulletin de la Société médicale d ’ Afrique noire de langue française , 23, 361‑364.
Andrès, E. (2014) Oral Cobalamin (Vitamin B12) Therapy in Pernicious Anemia. Autoimmunity Reviews , 13, 778. https://doi.org/10.1016/j.autrev.2014.01.057
Azzouz, Y., Abidi, S. and Chbicheb, S. (2023) Retrospective Cross-Sectional Study of 34 Cases of Pernicious Anemia at Mohammed V Military Training Hospital, Morocco. Pan African Medical Journal , 45, Article 79. https://doi.org/10.11604/pamj.2023.45.79.34204
Berri, M.A., Taous, A., Boulahri, T., Traibi, I. and Rouimi, A. (2019) Les troubles neurologiques secondaires à une carence en vitamine B12: Analyse de 29 cas. Pan African Medical Journal , 32, Article 108. https://doi.org/10.11604/pamj.2019.32.108.17690
Bahati, Y.L., Delanghe, J., Balaluka, G.B. and Philippé, J. (2022) Exploration of the Relationship between Anemia and Iron and Zinc Deficiencies in Children under 5 Years of Age Living in the Malaria Endemic Area of South Kivu/Democratic Republic of Congo. Annals of Hematology , 101, 1181-1189. https://doi.org/10.1007/s00277-022-04816-9
Mwangi, M.N., Mzembe, G., Moya, E. and Verhoef, H. (2021) Iron Deficiency Anaemia in Sub-Saharan Africa: A Review of Current Evidence and Primary Care Recommendations for High-Risk Groups. The Lancet Haematology , 8, e732-e743. https://doi.org/10.1016/s2352-3026(21)00193-9
Youssef, M.A.M., Hassan, E.S. and Yasien, D.G. (2020) Effect of Iron Deficiency Anemia on Language Development in Preschool Egyptian Children. International Journal of Pediatric Otorhinolaryngology , 135, Article 110114. https://doi.org/10.1016/j.ijporl.2020.110114
Zulfiqar, A., Dramé, M., Pennaforte, J., Novella, J., Vogel, T. and Andres, E. (2015) Iron Deficiency and Pernicious Anemia: A Rare Association? Annales de biologie clinique , 73, 420-426. https://doi.org/10.1684/abc.2015.1056
Faye, A. (2020) La maladie de Biermer : Aspects diagnostiques et évolutifs à l’hôpital de Tivaouane, Sénégal. Revue Africaine de Médecine Interne , 7, 31-36.
Koulidiati, J., Sawadogo, S., Sagna, Y., Somda, K.S., Tieno, H., Kafando, E., et al . (2015) Pernicious Anemia: Diagnosis and Course in Burkina Faso. Médecine et Santé Tropicales , 25, 428-431. https://doi.org/10.1684/mst.2014.0417
Kulnigg-Dabsch, S. (2016) Autoimmune gastritis. Wiener Medizinische Wochenschrift , 166, 424-430. https://doi.org/10.1007/s10354-016-0515-5
Htut, T.W., Thein, K.Z. and Oo, T.H. (2021) Pernicious Anemia: Pathophysiology and Diagnostic Difficulties. Journal of Evidence-Based Medicine , 14, 161-169. https://doi.org/10.1111/jebm.12435
Sidibé, E.H., Diop, A.N., Thiam, A. and Diop, S. (1999) Pernicious Anemia: The African Experience (3 Cases Reports). Sante ( Montrouge , France ), 9, 301‑304.
Savage, D., Gangaidzo, I., Lindenbaum, J., Kiire, C., Mukiibi, J.M., Moyo, A., et al . (1994) Vitamin B12 Deficiency Is the Primary Cause of Megaloblastic Anaemia in Zimbabwe. British Journal of Haematology , 86, 844-850. https://doi.org/10.1111/j.1365-2141.1994.tb04840.x
Seynabou, F., Fatou Samba Diago, N., Oulimata Diop, D., Abibatou Fall, S. and Nafissatou, D. (2016) Biermer Anemia: Hematologic Characteristics of 66 Patients in a Clinical Hematology Unit at Senegal. Médecine et Santé Tropicales , 26, 402-407. https://doi.org/10.1684/mst.2016.0625
Rustgi, S.D., Bijlani, P. and Shah, S.C. (2021) Autoimmune Gastritis, with or without Pernicious Anemia: Epidemiology, Risk Factors, and Clinical Management. Therapeutic Advances in Gastroenterology , 14, Article 175628482110387. https://doi.org/10.1177/17562848211038771
Nafil, H., Tazi, I., Sifessalam, M., Bouchtia, M. and Mahmal, L. (2013) Profil clinique, biologique, et thérapeutique de l’anémie par carence en vitamine B12 dans le service d’hématologie de Marrakech (Maroc). Bulletin de la Société de pathologie exotique , 106, 83-88. https://doi.org/10.1007/s13149-013-0282-4