Micronutrient deficiencies in patients with chronic atrophic autoimmune gastritis: A review

Table 1 Clinical and laboratory findings in vitamin B12 deficiency

General symptoms	Weight loss observed in most patients
	Low-grade fever occurs in one third of newly diagnosed patients and promptly disappears with treatment
Gastrointestinal symptoms	Smooth tongue (50% of patients) with loss of papillae. Changes in taste and loss of appetite
	Patients may report either constipation or having several semi-solid bowel movements daily
	Anorexia, nausea, vomiting, heartburn, pyrosis, flatulence and a sense of fullness
Brain	Altered mental status. Cognitive defects (“megaloblastic madness”): depression, mania, irritability, paranoia, delusions, lability
Sensory organs	Optic atrophy, anosmia, loss of taste, glossitis
Bone marrow	Hypercellular bone marrow
	Increased erythroid precursors
	Open, immature nuclear chromatin
	Dyssynchrony between maturation of cytoplasm and nuclei
	Giant bands, metamyelocytes
	Karyorrhexis, dysplasia
	Abnormal results on flow cytometry and cytogenetic analysis
Spinal cord	Myelopathy
	Spongy degeneration
	Paresthesias
	Loss of proprioception: vibration, position, ataxic gait, limb weakness/spasticity (hyperreflexia)
	Positive Romberg sign
	Lhermitte’s sign
	Segmental cutaneous sensory level
Autonomic nervous system	Postural hypotension
	Incontinence
	Impotence
Peripheral nervous system	Cutaneous sensory loss
	Hyporeflexia symmetric weakness
	Paresthesias
Genitourinary symptoms	Urinary retention and impaired micturition may occur because of spinal cord damage. This can predispose patients to urinary tract infections
Reproductive system	Infertility
Abnormalities in infants and children	Developmental delay or regression, permanent disability
	The patient does not smile
	Feeding difficulties
	Hypotonia, lethargy, coma
	Hyperirritability, convulsions, tremors, myoclonus
	Microcephaly
	Choreoathetoid movements, peripheral blood
	Macrocytic red cells, macro-ovalocytes
	Anisocytosis, fragmented forms
	Hypersegmented neutrophils
	Leukopenia, possible immature white cells
	Thrombocytopenia
	Pancytopenia
	Elevated lactate dehydrogenase level (extremes possible)
	Elevated indirect bilirubin and aspartate aminotransferase levels
	Decreased haptoglobin level
	Elevated levels of methylmalonic acid, homocysteine, or both