PT  - JOURNAL ARTICLE
AU  - S Khan
AU  - C Del-Duca
AU  - E Fenton
AU  - S Holding
AU  - J Hirst
AU  - P C Doré
AU  - W A C Sewell
TI  - Limited value of testing for intrinsic factor antibodies with negative gastric parietal cell antibodies in pernicious anaemia
AID  - 10.1136/jcp.2008.060509
DP  - 2009 May 01
TA  - Journal of Clinical Pathology
PG  - 439--441
VI  - 62
IP  - 5
4099  - http://jcp.bmj.com/content/62/5/439.short
4100  - http://jcp.bmj.com/content/62/5/439.full
SO  - J Clin Pathol2009 May 01; 62
AB  - Background: The appropriate testing strategy for diagnosing pernicious anaemia using gastric parietal cell (GPC) and/or intrinsic factor antibodies (IFA) is controversial. Intrinsic factor antibodies are found in only about 70% of cases. Indirect immunofluorescence screening for gastric parietal cell antibodies is more sensitive, labour intensive, and less specific.Methods: The frequency of antibody positivity (IFA and/or GPC) was retrospectively examined in patients tested for both autoantibodies over a three-year period. It was investigated whether B12 levels were related to antibody status. These findings were validated in a prospective study of IFA in 91 GPC negative patients with low B12 levels.Results: Of 847 samples identified in the retrospective study, 4 (0.47%) were positive for only intrinsic factor antibodies, 731 (86.3%) positive for GPC alone, and 112 (13.2%) for both. Student t test on log-transformed data showed B12 levels had no bearing on autoantibody status. 91 consecutive patients with low B12 levels were tested for both autoantibodies; all were negative for gastric parietal cell antibodies. Only one sample was positive for intrinsic factor antibody using the porcine intrinsic factor assay, but was negative by a human recombinant intrinsic factor-based ELISA.Conclusions: This study provides evidence that testing for gastric parietal cell antibodies is an appropriate screening test for pernicious anaemia, with intrinsic factor antibodies reserved for confirmatory testing or in patients with other autoantibodies that mask the GPC pattern; B12 levels are not related to autoantibody status.