Characteristics of patients with definite clinical responses to Cbl therapy
. | . | Causes of Cbl deficiency . | . | . | . | Comorbidities . | . | . | . | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Case . | Age/sex . | Schilling* . | IfAb . | Gastrin† . | Other . | DM . | EtOH . | Smoker . | Other . | ||||||
| 1 | 28/F | 5/10.6 | Eq | ND | None | No | No | No | Hypothyroid | ||||||
| 2 | 62/F | 5.3/18.1 | Neg | 210 | None | Yes | Yes | No | IgA deficiency | ||||||
| 3‡ | 73/M | 24/20 | Neg | 31 | None | No | Yes | Yes | Gout; carotene undetectable | ||||||
| 4 | 36/F | 24/26 | Neg | 66; 101 | None | No | No | No | 12 wk pregnant§ | ||||||
| 5 | 72/F | 23/19 | Neg | 38 | None | No | No | No | MGUS; CAD | ||||||
| 6 | 78/M | 8/8 | Neg | 49 | None | Yes | No | No | Calcium malab; CRF | ||||||
| 7 | 26/F | 27/26 | Neg | 35 | None | No | No | No | None | ||||||
| 8 | 27/F | ND | Neg | 29 | None | No | No | No | 24 wk pregnant∥ | ||||||
| 9 | 78/F | ND | Neg | 259; 406 | None | No | No | No | Hypothyroid; α-thalassemia | ||||||
| 10 | 70/F | ND | Neg | 48 | None | No | No | Yes | Psoriasis | ||||||
| 11 | 81/F | ND | Neg | 20 | None | No | No | No | CRF; MGUS | ||||||
| 12 | 59/F | ND | Pos | 24 | None | No | No | No | None | ||||||
| 13 | 78/M | ND | Neg | 33 | None | No | No | No | CAD | ||||||
| 14 | 70/F | ND | Pos | 122 | Tagamet | Yes | No | No | GERD; CAD | ||||||
| 15 | 68/M | ND | Neg | 22 | None | Yes | No | No | CAD | ||||||
| 16 | 82/M | ND | Neg | ND | None | No | No | No | Hypothyroid | ||||||
| 17 | 77/F | 21/17 | Pos | 32 | None | No | No | No | CAD; spinal stenosis | ||||||
| 18 | 82/M | ND | Neg | 26 | None | Yes | No | No | CAD | ||||||
| 19 | 79/M | 31/26 | Pos | 23 | Duod. divertic | No | No | No | Hypothyroid | ||||||
| 20 | 74/M | ND | ND | ND | None | No | No | No | None | ||||||
| 21 | 71/M | ND | ND | ND | None | No | No | No | MGUS | ||||||
| 22 | 77/F | ND | Neg | 38 | None | No | No | No | None | ||||||
| 23 | 77/M | ND | Neg | 17 | None | Yes | No | No | CAD | ||||||
| 24 | 63/F | ND | ND | ND | Cimetidine | Yes | No | No | None | ||||||
| 25 | 46/F | 28/21 | ND | ND | Vegetarian | No | No | No | None | ||||||
| 26 | 55/F | ND | Neg | 34 | None | No | No | Yes | Psoriasis | ||||||
| 27 | 62/F | 3.2/2.6 | ND | ND | None | Yes | No | No | CAD | ||||||
| 28 | 58/F | ND | Pos | ND | None | Yes | No | No | CAD | ||||||
| 29 | 56/F | ND | Neg | 32 | None | No | No | No | Colloid goiter | ||||||
| 30 | 66/F | ND | Neg | 22 | None | No | No | No | Hypothyroid | ||||||
| 31 | 39/F | ND | Neg | 25 | Vegetarian | No | No | No | None | ||||||
| 32 | 53/F | ND | Eq | 111;81 | Tagamet | Yes | No | No | CRF | ||||||
| 33 | 28/F | ND | Eq | 25 | None | No | No | No | None | ||||||
| 34 | 48/F | 33/36 | Neg | 18 | None | No | No | No | None | ||||||
| 35 | 70/M | ND | Neg | 39 | None | No | No | No | None | ||||||
| 36 | 68/M | ND | Neg | 46 | None | No | No | No | 2 yr s/p colon cancer | ||||||
| 37 | 77/M | ND | Neg | 13 | None | No | No | No | CAD; CVA; autonomic dysfunction | ||||||
. | . | Causes of Cbl deficiency . | . | . | . | Comorbidities . | . | . | . | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Case . | Age/sex . | Schilling* . | IfAb . | Gastrin† . | Other . | DM . | EtOH . | Smoker . | Other . | ||||||
| 1 | 28/F | 5/10.6 | Eq | ND | None | No | No | No | Hypothyroid | ||||||
| 2 | 62/F | 5.3/18.1 | Neg | 210 | None | Yes | Yes | No | IgA deficiency | ||||||
| 3‡ | 73/M | 24/20 | Neg | 31 | None | No | Yes | Yes | Gout; carotene undetectable | ||||||
| 4 | 36/F | 24/26 | Neg | 66; 101 | None | No | No | No | 12 wk pregnant§ | ||||||
| 5 | 72/F | 23/19 | Neg | 38 | None | No | No | No | MGUS; CAD | ||||||
| 6 | 78/M | 8/8 | Neg | 49 | None | Yes | No | No | Calcium malab; CRF | ||||||
| 7 | 26/F | 27/26 | Neg | 35 | None | No | No | No | None | ||||||
| 8 | 27/F | ND | Neg | 29 | None | No | No | No | 24 wk pregnant∥ | ||||||
| 9 | 78/F | ND | Neg | 259; 406 | None | No | No | No | Hypothyroid; α-thalassemia | ||||||
| 10 | 70/F | ND | Neg | 48 | None | No | No | Yes | Psoriasis | ||||||
| 11 | 81/F | ND | Neg | 20 | None | No | No | No | CRF; MGUS | ||||||
| 12 | 59/F | ND | Pos | 24 | None | No | No | No | None | ||||||
| 13 | 78/M | ND | Neg | 33 | None | No | No | No | CAD | ||||||
| 14 | 70/F | ND | Pos | 122 | Tagamet | Yes | No | No | GERD; CAD | ||||||
| 15 | 68/M | ND | Neg | 22 | None | Yes | No | No | CAD | ||||||
| 16 | 82/M | ND | Neg | ND | None | No | No | No | Hypothyroid | ||||||
| 17 | 77/F | 21/17 | Pos | 32 | None | No | No | No | CAD; spinal stenosis | ||||||
| 18 | 82/M | ND | Neg | 26 | None | Yes | No | No | CAD | ||||||
| 19 | 79/M | 31/26 | Pos | 23 | Duod. divertic | No | No | No | Hypothyroid | ||||||
| 20 | 74/M | ND | ND | ND | None | No | No | No | None | ||||||
| 21 | 71/M | ND | ND | ND | None | No | No | No | MGUS | ||||||
| 22 | 77/F | ND | Neg | 38 | None | No | No | No | None | ||||||
| 23 | 77/M | ND | Neg | 17 | None | Yes | No | No | CAD | ||||||
| 24 | 63/F | ND | ND | ND | Cimetidine | Yes | No | No | None | ||||||
| 25 | 46/F | 28/21 | ND | ND | Vegetarian | No | No | No | None | ||||||
| 26 | 55/F | ND | Neg | 34 | None | No | No | Yes | Psoriasis | ||||||
| 27 | 62/F | 3.2/2.6 | ND | ND | None | Yes | No | No | CAD | ||||||
| 28 | 58/F | ND | Pos | ND | None | Yes | No | No | CAD | ||||||
| 29 | 56/F | ND | Neg | 32 | None | No | No | No | Colloid goiter | ||||||
| 30 | 66/F | ND | Neg | 22 | None | No | No | No | Hypothyroid | ||||||
| 31 | 39/F | ND | Neg | 25 | Vegetarian | No | No | No | None | ||||||
| 32 | 53/F | ND | Eq | 111;81 | Tagamet | Yes | No | No | CRF | ||||||
| 33 | 28/F | ND | Eq | 25 | None | No | No | No | None | ||||||
| 34 | 48/F | 33/36 | Neg | 18 | None | No | No | No | None | ||||||
| 35 | 70/M | ND | Neg | 39 | None | No | No | No | None | ||||||
| 36 | 68/M | ND | Neg | 46 | None | No | No | No | 2 yr s/p colon cancer | ||||||
| 37 | 77/M | ND | Neg | 13 | None | No | No | No | CAD; CVA; autonomic dysfunction | ||||||
Patients 1 to 8 had hematologic responses to Cbl therapy. Patients 9 to 37 had neurologic responses to Cbl therapy. Cbl indicates cobalamin; IfAB, intrinsic factor antibody; EtOH, ethanol abuse; Eq, equivocal; ND, not done; Neg, negative; MGUS, monoclonal gammopathy of undetermined significance; CAD, coronary artery disease; malab, malabsorption; CRF, chronic renal failure; Pos, positive; GERD, gastroesophageal reflux disease; Duod. divertic, duodenal diverticulum; CVA, cerebrovascular accident; DM, diabetes mellitus; and s/p, after.
Schilling test values are given as % excretion without IF/% excretion with IF, with normal values being 9% to 33%/8% to 34%
Gastrin values are pg/mL, with a normal range up to 40 pg/mL.
The patient had both hematologic and neurologic responses to Cbl therapy.
Patient 4 was 12 weeks pregnant but had an MCV of 109 documented 1 year previously. Her MCV fell to 98 after 1 month of Cbl therapy (5 months before delivery). She was taking prenatal multivitamins with iron throughout her pregnancy.
Patient 8 was 24 weeks pregnant with a hematocrit (Hct) of .29 and an MCV of 100. Her Hct increased to .35 after 6 weeks of Cbl therapy without a change in MCV, and she delivered 2 weeks later. She was taking prenatal multivitamins with iron throughout her pregnancy.