抄録
A 68-year-old female patient was admitted because of severe anemia. Physical examination revealed anemia, papillary atrophy of tongue, systolic heart murmur and ecchymosis. Peripheral blood examination showed pancytopenia; RBC 154×104/cmm, Hb 6.1g/dl, MCV 114 fl, WBC 1,900/cmm, and platelet count 4.4×104/cmm. Erythroblasts and hypersegmented neutrophils were observed in the smear of pripheral blood. Bone marrow study revealed megaloblastic changes in the erythroid series and also myeloid series, with 18% plasma cells. The laboratory data, such as the low VB12, normal folic acid, high LDH, positive Schilling test, anti-intrinsic factor antibody, and achlorhydria, supported the diagnosis of pernicious anemia. The total protein was 9.7 g/dl. M-component (IgG-λ) was detected in serum in γ-region by immunoelectrophoresis. Bence Jones protein in urine was negative. Radiologic examination of the bone revealed no abnormality.
By the treatment of VB12, improvement of anemia and disappearance of megaloblasts in the bone marrow were observed. There was no significant change in the level of M-component in serum or the percentage of plasma cells in the bone marrow during 19 months, although slight change in plasma cells was noted morphologically. The hypergammaglobulinemia may be of benign type, but possibility of myeloma still remains.
About thirty cases of pernicious anemia in association with monoclonal hypergammaglobulinemia have been reported in the world. In our coutry, this is the second case.
