Schilling evaluation of pernicious anemia: Current status

L. S. Zuckier, L. R. Chervu

Research output: Contribution to journalArticle

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Abstract

The Schilling examination remains a popular means of evaluating in vivo absorption of vitamin B12. When absorption is abnormally low, the test may be repeated wih addition of exogenous intrinsic factor (IF) in order to correct the IF deficiency that characterizes pernicious anemia. A dual-isotope variation provides a means of performing both stages of the test simultaneously, thereby speeding up the test and reducing dependence on complete urine collection. The dual-tracer test depends on no exchange of B12 moieties on the IF molecule. In vitro studies suggest that this exchange does take place, in a manner dependent on time, temperature, and pH. Furthermore, in vivo studies indicate that, when administered simultaneously, the absorption of unbound B12 is elevated, and If-bound B12 is reduced, in pernicious-anemia patients, relative to the classic two-stage examination. A number of clinical studies indicate significant difficulty in resolving clinical diagnoses with the dual-tracer test. The potential weaknesses of the test discussed herein can be overcome by temporally separating the administration of the two B12 doses and by treating secondary malabsorption where it exists. An algorithm is offered for selecting the most suitable variation of the Schilling test to improve the accuracy of test results and the ease of performance.

Original languageEnglish (US)
Pages (from-to)1032-1039
Number of pages8
JournalJournal of Nuclear Medicine
Volume25
Issue number9
Publication statusPublished - Jan 1 1984

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ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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