悪性貧血の1例

PERNICIOUS ANEMIA

Ⅰ．はじめに

　悪性貧血は代表的な巨赤芽球性貧血であるが，胃の内因子分泌の欠如によるビタミンB₁₂の吸収障害を本態とする疾患である．以下にはまずわれわれが最近経験した症例を示し，ついで本症にっいての一般的事項と近年の知見の一部を紹介したい．

　Gastrointestinal complaints and/or discovery of related abnormal findings often precede anemic symptoms in Addisonian pernicious anemia. In the case here presented, the patient was a fifty-six years old male with anorexia and soreness of tongue as chief complaints. The diagnosis given before admission to our hospital was atrophic gastritis in one outpatient clinic, and that accompanied by anemia of obscure origin in another.

　Bone marrow biopsy soon after admission revealed typical megaloblastic proliferation, and hematological examinations together with low serum vitamin B₁₂ level and positive Schilling tests confirmed the diagnosis. Achlorhydria persisted after histalog and gastrin stimulation, but neuro logical abnormalities were lacking.

　Endoscopic examinations were repeated with Gastrofiberscope (Machida) before, during and after successful VB₁₂ administration, and diffuse and pronounced gastric atrophy was observed throughout. Gastric biopsy simultaneously performed revealed marked mucosal atrophy and intestinal metaplasia.

　After the case presentation follows a brief review of the disease with emphasis on recent laboratory findings. Lastly, warnings are given against a growing tendency among laymen and the medical rofession toward easy going dependence upon “shot-gun” antianemic drugs and multivitamin preparations, which may temporarilly normalize the blood picture and thereby endanger the correct diagnosis of this lifelong disease.