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Open Access Highly Accessed Case report

Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia

Ayyash Melhem, Ankit Desai and Marion A Hofmann*

Thrombosis Journal 2009, 7:5  doi:10.1186/1477-9560-7-5

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severe hyperhomocystemia is common in patients with pernicious anemia

Marion Hofmann   (2010-02-11 14:41)  University of Chicago email

We would like to make an addendum to our case report. In contrast to what we reported, the severity of hyperhomocystenemia (105 μM) in our case is not unusually high for patients with vitamin B12 deficiency caused by pernicious anemia. A large cohort study by Savage and colleagues (ref 1) measured homocysteine in 408 patients with vitamin B12 deficiency, of which 234 (58%) had proven pernicious anemia and 76 (18%) had probable pernicious anemia. This case series accumulated over 21 years and is the largest study in the literature reporting homocysteine determinations in patients with pernicious anemia. In this study, the mean homocysteine level was 89.4 μM (with a range of approximately 18-475 μM) in anemic patients with vitamin B12 deficiency. Unfortunately, the incidence of thrombotic complications was not reported in this large cohort of patients with moderate to severe hyperhomocystenemia.
We apologize for omission of this landmark study. Nevertheless, it does not change our conclusion that severe hyperhomocystenemia needs to be considered in the work-up of acute myocardial infarction not explained by atherosclerotic heart disease.

1. Savage D.G, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med 1994 (96): 239-246

Competing interests

None declared


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