KRİPTOJENİK KARACİĞER SİROZU - PERNİSİYÖZ ANEMİ BİRLİKTELİĞİ

Öz

Karaciğer sirozunda hipersplenizme bağlı olarak değişik derecede sitopeniler görülebilir. Ancak ağır pansitopeni mutad değildir. Bu durumda kemik iliğini infiltre eden hastalıklar ile birlikte, pansitopeniyle seyreden pernisyöz anemi de ayırıcı tanıda akla gelmelidir. Literatürde kronik karaciğer hastalığı (primer biliyer siroz, otoimmün hepatit vb) ile pernisyöz anemi birlikteliği, vaka sunumları şeklinde bildirilmiştir. Bu yazıda, ağır pansitopeni ile başvuran ve kriptojenik siroz olduğu saptanan pernisyöz anemili bir vaka sunulmuştur.

Anahtar Kelimeler

• Megaloblastik anemi, pernisiyöz anemi, pansitopeni, hipersplenizm, siroz

Kaynakça

1. Aitelli C, Wasson L, Page R. Pernicious anemia: presentations mimicking acute leukemia.South. Med J 2004; 97:295-297.
2. Alderuccio F, Sentry J.W., Marshall A.C., Biondo M, Toh B.H. Animal models of human disease: experimental autoimmune gastritis. A model for autoimmune gastritis and pernicious ane- mia, Clin Immunol 2002; 102:48-58.
3. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Des- met VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathco- te J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Büschenfelde KH, Zeniya M, In- ternational Autoimmune Hepatitis Group Report: Review criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31: 929-938.
4. Andres E, Loukili NH, Ben Abdelghani M, Noel E. Pernicious anemia associated with interferon-alpha therapy and chronic he- patitis C infection. J Clin Gastroenterol 2004 ; 38:382-385.
5. Angela GC, Fazio A case of pernicious anemia associated with hepatic cirrhosis M. Gazz Med Ital 1953; 112:68-71.
6. Aoyama H, Sakugawa H, Nakasone H, Nakayoshi T, Kinjo A, Tamayose M, Higa H, Uema A, Chinen T, Tomiyama R, Uchi- ma N, Kugai Y, Kinjo F, Saito A and Kinjo M. A rare associati- on of primary biliary cirrhosis and pernicious anemia. J Gastro- enterol 2002; 37: 560-563.
7. Attout H, Guez S, Series C. Association of hereditary hemoch- romatosis and pernicious anaemia Rev. Med. Interne 2004 ; 25:759-761.
8. Bergwitz C, Brabant G, Trautwein C, Manns MP. A patient with autoimmune hepatitis type I, Addison's disease, atrophic thyro- iditis, atrophic gastritis, exocrine pancreatic insufficiency, and heterozygous alpha1-antitrypsin deficiency. Am J Gastroenterol 2002; 97:1050-1052.

9. Deanne LV, Greenwoda John W. Sentrya, Murine experimental autoimmune gastritis models refractive to development of intrin- sic factor autoantibodies, cobalamin deficiency and pernicious anemia. Clin Immunol 2007; 122, 41-52.
10. Dohmen K. Primary biliary cirrhosis and pernicious anemia Gastroenterology and Hepatology 2001; 16: 1316-1318.
11. Field J, Biondo MA, Murphy K, Alderuccio F, Toh BH. Experi- mental autoimmune gastritis: mouse models of human organ- specific autoimmune disease, Int. Rev. Immunol 2005; 24: 93- 110.
12. Kazufimi D, Hirohisa S, Yuichi M, Fumio Y, Koji I, Hiromi I. Atrophic Corpus Gastritis and Helicobacter Pylori Infection in Primary Biliary Cirrhosis. Digestive Diseases and Sciences, 2002; 47: 1, 162–169.
13. Loukili NH, Noel E, Blaison G, Goichot B, Kaltenbach G, Ron- deau M, Andres E. [Update of pernicious anemia. A retrospecti- ve study of 49 cases] Rev. Med. Interne 2004 ; 25:556-561.
14. Olmer J, Moutaffian A case of Biermer's anemia with liver cirr- hosis (development followed for 14 years, death due to hepato- carcinoma)] JJ.Mars Med 1969; 106; 345-348.
15. Scalabrino G, Peracchi M. New insights into the pathophysi- ology of cobalamin deficiency Trends in Molecular Medicine 2006; 12:6, 247-254.
16. Takahashi T, Honma T, Ishizuka K, Fuse I, Asakura H. A fema- le with asymptomatic primary biliary cirrhosis associated with pernicious anemia. J. Gastroenterol Hepatol 2001; 1: 6, 1420- 1424.