Oral cobalamin for treatment of pernicious anemia?

Article Abstract:

Pernicious anemia is a vitamin B12 (cobalamin) deficiency disorder resulting from the absence of intrinsic factor (IF), which is needed for the absorption of vitamin B12. Cobalamin is stored extensively in the liver, and a lack of this vitamin in the diet is rare, and usually occurs only in strict vegetarians who do not consume animal products. IF deficiency may result from atrophy of the stomach, total or partial gastrectomy (the surgical removal of the stomach), or genetically-determined failure to produce IF. Orally administered IF was previously used to treat pernicious anemia, but was difficult to obtain and costly. Within the past 30 years, pernicious anemia has been treated with cobalamin injected into the muscle in doses of 1,000 micrograms (ug) every one to three months. Intramuscular injections of cobalamin provide completely adequate cobalamin nutrition, but may be difficult in extremely thin patients with little muscle mass. Hence, oral preparations of cobalamin have been developed, but the safety, effectiveness, and acceptability of oral cobalamin has yet to be demonstrated. Oral cobalamin is effective in treating pernicious anemia in doses of 300 to 1,000 ug or more per day. These large doses of oral cobalamin do not appear to cause toxic effects. Severe cobalamin deficiency should be initially treated with injectable cobalamin; oral cobalamin is not recommended for patients without a defect in IF absorption. A recent study showed that patient compliance with injectable cobalamin was good and slightly more patients preferred a monthly injection over a daily pill. Although the majority of physicians agreed that an inexpensive, effective daily cobalamin pill would be useful in treating pernicious anemia, most were unaware of the availability of an effective oral cobalamin therapy. Although oral preparations of cobalamin are available over-the-counter, patients with pernicious anemia should continue to be monitored by their physicians. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Pernicious anemia, Vitamin B12, editorial

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A Structured Teaching and Self-management Program for Patients Receiving Oral Anticoagulation: A Randomized Controlled Trial

Article Abstract:

Many patients who take anticoagulant drugs can be taught to manage the dosage to prevent blood clotting or excessive bleeding. These drugs are used to prevent blood clot formation, but high levels can cause bleeding. Researchers randomly assigned 179 patients on anticoagulants to receive standard care or to go through an educational program that taught them to administer their own blood tests and control the dose of drug. Patients who received this training were more likely to have optimal blood levels of the drug.

Germany, Evaluation, Anticoagulants (Medicine), Anticoagulants, Patient education

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