Autoimmunity in Iron-deficiency Anaemia.

There is recent evidence to suggest that an autoimmune mechanism may be associated with the gastric mucosal changes found in pernicious anaemia. Markson and Moore (1962) and Irvine et al. (1962) found a complement-fixing antibody to gastric mucosa in the blood of 42% and 75% respectively of their patients with pernicious anaemia; and Taylor et al. (1962), using an immunofluorescent technique, demonstrated an organ-specific autoantibody in 85% of 100 patients. These last workers also showed that the antigen was localized in the cytoplasm of the parietal cells, and was recoverable in the " microsomal " fraction of homogenized gastric mucosa. The autoantibody to gastric parietal cells was shown to be quite distinct from the antibody to intrinsic factor first described by Taylor (1959). These studies have been extended to include observations on patients with iron-deficiency anaemia. Markson and Moore (1962), using a complement-fixation test in 34 patients with iron-deficiency anaemia, found that 17.6% of these had gastric autoantibodies; there were no positive tests in 34 matched control subjects. Gastric achlorhydria is twice as common in patients with iron-deficiency anaemia as in normal subjects, and four times as common in patients under 50 years (Joske et al., 1955 ; Badenoch et al., 1957). There is an increased incidence of chronic gastritis in iron-deficiency anaemia, and not infrequently the mucosal changes are closely similar to those found in pernicious anaemia (Davidson and Markson, 1955). Furthermore, a good correlation exists between the presence of a histamine-fast achlorhydria and the finding of a severe degree of chronic gastritis (Bock et al., 1963). It was for these reasons that we have investigated by an immunofluorescent test the incidence of gastric autoantibodies in the sera of 64 patients with iron-deficiency anaemia, and have related the occurrence of positive results to the presence or absence of a histamine-fast achlorhydria.