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Ralph Carmel, MD
San Antonio

JAMA. 1970;213(10):1686-1687.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Pernicious anemia requires as its sine qua non the absence of intrinsic factor. Without demonstration of such a defect, either by Schilling test with and without exogenous intrinsic factor or, preferably, by direct assay for intrinsic factor, one can not be certain of the diagnosis. Wintrobe,¹ in listing causes of megaloblastic anemia, mentions 22 categories in addition to addisonian pernicious anemia. Indeed, it is probable that even in the United States the majority of patients with megaloblastic anemia do not have pernicious anemia (though it remains the most common cause of vitamin B₁₂ deficiency).

The coexistence of neurological symptoms and gastric achlorhydria with megaloblastic anemia is very suggestive of the disease, but not diagnostic.¹ It is, for example, conceivable that alcoholic neuropathy, chronic gastritis with achlorhydria, and folic acid deficiency could be the presenting symptoms of a chronic alcoholic, though alcoholism was not a . . . [Full Text PDF of this Article]

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