Pernicious anemia without gastric atrophy and in the presence of free hydrochloric acid; report of a case.

I)I)ISONIAN pernicious anemnia is ami expressiomi of the deficiemicy of vitan imi B12 which results from lack of secretion of Castle’s imit.rimisic factor iii the stomach. It has been kuioivn to be associated with atrophy of the gastric mucosa for about 80 yearst and with gastric achlorhydria for 70 years.2 The latter has been so constant. a fimiding that it has almost always been regarded as essential for the diagnosis. Sturgistm states that. the diagnosis of permiicious anemia should not even be considered if free hydrochloric acid is presemit in the gastric secretions. Occasiomial repomts have beemi pul)hished of apparelit pernicious anemia associated w-ith fm-ce hydrochloric acid imi the stomach.4 Proof is lacking in almost all such cases that the mnegaloblastic anemnia has i)eemi clue to deficiemicy of intrimisic factor amid miot to imitestimmal Iiialabsorptiomm, pregmiancy, nutritional deficiency, or to other u-arer causes, most of which ale usually associated with free hydrochloric acid iii the stomach. The preparat.iomi of vitamin B12 labeled with a radioactive isotope of cobalt. has made available a mnore accumat.e technic foi the study of intrimisic factor activity.5’ 6 Iii addit.ioui, techmiics have beemi developed recently for the estimat.ion of vitamin B12 levels in the serum7-9; for the demnonstrat.ion of fohic aci(l mnalabsorpt.ion from the gut.,’#{176} and for obtaining a biopsy of the gastri( mucosa i)y a flexible gastric l)iopsy tube.’tm Omily one case has so far beemi published’2 using such techmii(s to confirmu the diagmiosis of Addisonian permiicious anemia ill a patient whose gastric fliu(Osa showed a miormal histologic pattermi amid secreted nornial amouuits of hydrochloric acid. We are reporting a second case, developing at the age of 16 years, and showing certain (hifferences fromn the patiemit r(’ported by Molhin, Baker amid I )ouiiach 12