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Hyperhomocysteinemia-associated Thrombosis in Patients With Pernicious Anemia
Thura W Htut1, Kyaw Z Thein2, Thein H Oo3
1Department of Haematology, Aberdeen Royal Infirmary, University of Aberdeen, NHS Grampian, Aberdeen, UK.
Journal of Community Hospital Internal Medicine Perspectives
|January 27, 2025
Summary
Pernicious anemia (PA) can cause hyperhomocysteinemia-associated thrombosis (HAT), often presenting at unusual sites with neuropsychiatric symptoms. Treatment with cobalamin replacement and antithrombotics showed a low rate of recurrent thrombosis.
Area of Science:
- Hematology
- Gastroenterology
- Neurology
Background:
- Cobalamin deficiency (CD) from pernicious anemia (PA) causes hyperhomocysteinemia, a known risk factor for thrombosis.
- The clinical characteristics and outcomes of hyperhomocysteinemia-associated thrombosis (HAT) linked to PA remain poorly understood.
Purpose of the Study:
- To elucidate the clinical features and outcomes of patients experiencing hyperhomocysteinemia-associated thrombosis (HAT) secondary to pernicious anemia (PA).
Main Methods:
- A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases up to January 2024.
- Keywords included "pernicious anemia AND thrombosis" and related terms to identify relevant published studies.
- The review focused on extracting clinical data to characterize PA-related HAT.
Main Results:
- The study analyzed 20 patients with a median age of 54.5 years; 35% were elderly.
- Significant findings included thromboses at multiple or unusual sites (35% and 20%, respectively), and co-existing neuropsychiatric symptoms (45%).
- Eighty percent tested positive for anti-intrinsic factor (anti-IF) antibodies, and no recurrent thromboembolism was observed after treatment.
Conclusions:
- Pernicious anemia-related hyperhomocysteinemia-associated thrombosis is a rare condition characterized by a high incidence of unusual/multiple thromboses and associated neuropsychiatric symptoms.
- A high rate of anti-intrinsic factor antibody positivity was noted.
- Cobalamin replacement and antithrombotic therapy appear effective in preventing recurrent thromboembolic events.
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