IMMUNOGLOBULINS IN PERNICIOUS ANAEMIA

Plasma cell dyscrasias: current status

This is a review of the current status of the monoclonal gammopathies (plasma cell dyscrasias). We begin with the recognition of a monoclonal protein in serum and urine. We briefly discuss the differential diagnosis of the monoclonal gammopathies. Clinical and laboratory findings as well as the management of multiple myeloma are addressed. Future approaches for the treatment of myeloma are provided. The variant forms of multiple myeloma, including smoldering myeloma, plasma cell leukemia, nonsecretory myeloma, IgD myeloma, osteosclerotic myeloma, solitary plasmacytoma of bone, and extramedullary plasmacytoma, are briefly reviewed. Diagnosis and treatment of Waldenström's macroglobulinemia are presented. The recognition and differential diagnosis of the heavy-chain diseases (gamma, alpha, and mu) are included. Monoclonal gammopathy of undetermined significance ("benign" monoclonal gammopathy) is presented in detail. Amyloidosis is not included in this review.

Lymphocyte surface phenotypes in pernicious anemia

Because an immunological defect of an unknown nature is thought to be a factor in the pathogenesis of pernicious anemia, we studied lymphocyte surface phenotypes in 40 patients and compared them with 113 healthy controls. The only significant difference that emerged was in their slightly decreased number and proportion of surface immunoglobulin (lambda chain) -bearing cells. Of specific interest, the numbers of OKT4+ and OKT8+ lymphocytes and the T4+/T8+ ratios were not significantly different from control values. A sizable minority of patients had increased ratios, while a smaller number had decreased values. No explanation or identifying feature was apparent for those patients with either increased or decreased T4+/T8+ ratios. (One patient with a very low ratio, who was excluded from our analysis, developed acquired immune deficiency syndrome.) No differences were apparent in T4+/T8+ ratios or any other lymphocyte surface phenotypic characteristics when patients were segregated by presence of anti-intrinsic factor antibody or anti-parietal cell antibody, or by race, sex, or age. Our results in a racially heterogeneous group of patients do not support the suggestion that T4+/T8+ ratios are usually abnormal in prenicious anemia or that the presence of anti-intrinsic factor antibody is associated with such abnormality.

Immunoglobulin deficiency responding to vitamin B12 in two elderly patients with megaloblastic anaemia

Two elderly patients with vitamin B12 deficiency were found to have low immunoglobulin levels. These returned to normal on treatment with vitamin B12.

Reversible C3 hypocomplementaemia in megaloblastic anaemia due to vitamin B12 deficiency

Serum C3 and C4 levels have been determined in patients with Addisonian pernicious anaemia (PA) and megaloblastic anaemia due to vitamin B12 deficiency from other causes, before and after treatment, in order to study the interaction between vitamin B12 deficiency and complement and the role of complement in the pathogenesis of the gastric lesion of PA. C3 levels are significantly reduced in vitamin B12 deficiency and return to normal on treatment; C3 levels correlate with the degree of anaemia but not with serum vitamin B12 levels at diagnosis. C4 levels are normal. These observations suggest that the observed C3 hypocomplementaemia is not a consequence of immune mechanisms, but may be due to altered synthesis of C3 complement component.

Nonmalignant monoclonal immunoglobulinemia, pernicious anemia and gastric carcinoma. A model of immunologic dysfunction. Report of two cases and review of the literature

The association of an autoimmune disease with a monoclonal immunoglobulin is not exceptional and most probably results from a dysfunction of the immunologic apparatus. This study describes two patients with monoclonal immunoglobulin A (IgA) and M (IgM) gammopathy, respectively, in whom pernicious anemia and finally gastric carcinoma developed. One patient had autoantibodies to gastric parietal cell and to thyroid microsomal antigen which could not be identified with the M-component. This observation, together with the fact that pernicious anemia occurred in one case before and in the other case after the discovery of M-component, suggests that different clones of cells were responsible for both disorders. Sixteen cases in which the patients had the same association have been collected from the literature and the data are compared with ours.