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Rice¹ indicates that "a patient presenting with blood changes indicative of megaloblastic anemia, a low B₁₂ level, and no history of veganism or gastrointestinal disease could realistically have nothing other than pernicious anemia." He suggests that "the results of antibody tests would add little information to the diagnosis" and that the Schilling test is not important in the management of macrocytic anemia. We disagree with these assertions.

In a retrospective study² that was conducted in 1994 and 1995, we demonstrated that a majority (55%) of cases of cyanocobalamin (vitamin B₁₂) deficiency were related to the inability to release cobalamin from food (fulfilling the definition of Carmel³) and that pernicious anemia was a rare condition (17%). In a second retrospective study⁴ that was conducted between 1995 and 1998, we confirmed that food cobalamin malabsorption was emerging as a major cause of vitamin B₁₂ deficiency. We found that 68 patients . . . [Full Text of this Article]

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