The Urinary Excretion Test in the Diagnosis of Addisonian Pernicious Anemia

ADDISONIAN pernicious anemia is a deficiency disease resulting from the lack of a specific gastric secretion which is essential for the optimal absorp-tion in the intestine of orally ingested vitamin B12. Probably a muco-protein,1 '2 this gastric enzyme, commonly referred to as intrinsic factor,3'4 is produced by the mucosal cells of the stomach of man and other animals. It has not yet been fully characterized chemically, nor is there available a direct method for detecting its presence in the stomach secretions. In hematologic relapse the diagnosis of pernicious anemia is readily established by the findings of megaloblastic erythropoiesis, macrocytic normochromic anemia, leukopenia, gastric achlorhydria, with or without the neurologic evidences of combined system disease. Treatment with vitamin B12 or liver extract induces a complete hematologic remission, and this form of treatment is continuously required throughout the patient's life. Without a knowledge of the hematologic findings prior to treatment, it is extremely difficult to establish a diagnosis of pernicious anemia after