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August 1960

Treatment of Pernicious Anemia with Orally Administered Cyanocobalamin (Vitamin B12)

Author Affiliations


From the Department of Medicine, The Johns Hopkins University and Hospital.

Arch Intern Med. 1960;106(2):280-292. doi:10.1001/archinte.1960.03820020120018

Introduction  Parenteral injection of cyanocobalamin (Vitamin B12) is well established as an effective and reliable treatment for pernicious anemia. In contrast, currently available preparations for oral use have proved to be much less dependable.1 A study was initiated in 1950 in the hematology clinic of The Johns Hopkins Hospital to determine whether relatively large amounts of pure cyanocobalamin, when administered orally without intrinsic factor or other adjuvants, would provide adequate therapy for patients with pernicious anemia. The early results of this investigation2-4 as well as those obtained in other clinics 5-11 were favorable. This paper provides further observations on a group of patients receiving various doses of orally administered cyanocobalamin for periods of up to six and one-half years.

Materials and Methods  The diagnosis of pernicious anemia had been well established by clinical and hematological criteria in each patient chosen to participate in this study. In many

Serum cyanocobalamin levels were determined in the laboratories of the Division of Clinical Pathology, Department of Medicine, at the University of Maryland School of Medicine through the courtesy of Dr. M. S. Sacks and Dr. C. Spurling.
A normal concentration of cyanocobalamin in serum is not required for persisting and apparently complete hematological and clinical remission. Nevertheless, a regimen of therapy which provides normal serum levels gives complete assurance of adequacy of therapy. This assurance is particularly desirable when there are neurological manifestations.
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