{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T09:40:27Z","timestamp":1765705227450,"version":"3.48.0"},"reference-count":23,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Clin Pathol"],"published-print":{"date-parts":[[1979,3]]},"abstract":"\n The definitive diagnosis of pernicious anaemia (PA) in the elderly is by no means always straightforward, particularly when inappropriate medication has been introduced before the institution of specific investigatory procedures. A detailed haematological study was carried out on 301 patients aged 60-95 with a serum B\n 12<\/jats:sub>\n concentration at the laboratory's lower level of normal of 150 ng per litre (\n Euglena gracilis<\/jats:italic>\n assay).\n <\/jats:p>\n \n The diagnosis of PA was based on strict predetermined haematological criteria. All patients were subsequently studied by the simultaneous oral administration of the dual isotopes\n 57<\/jats:sup>\n Co-labelled B\n 12<\/jats:sub>\n bound to intrinsic factor and free\n 58<\/jats:sup>\n Co-labelled B\n 12<\/jats:sub>\n (Dicopac test), and urine was collected over 24 hours after an intramuscular dose of 1 mg nonradioactive B\n 12<\/jats:sub>\n for estimation of the\n 57<\/jats:sup>\n Co\/\n 58<\/jats:sup>\n Co B\n 12<\/jats:sub>\n ratio; 255 patients satisfied all criteria for final analysis.\n <\/jats:p>\n \n The Radiochemical Centre, Amersham suggests an upper limit of the normal range for the\n 57<\/jats:sup>\n Co\/\n 58<\/jats:sup>\n Co ratio of 1\u00b73 with a lower limit for PA of 2\u00b70. We were unable to show a sharp borderline in the\n 57<\/jats:sup>\n Co\/\n 58<\/jats:sup>\n Co B\n 12<\/jats:sub>\n ratio between those patients shown by other criteria to have PA and those who do not have PA; 34% of the 71 established patients had a ratio below 2\u00b70. From our series a ratio borderline drawn at 1\u00b74 gave only one false negative (1\u00b74% of the PA group). Of the 175 non-PA cases, nine (5%) gave false positive results; four of these had\n 58<\/jats:sup>\n Co excretion levels high enough to make misdiagnosis unlikely.\n <\/jats:p>\n \n In a proportion of patients the\n 57<\/jats:sup>\n Co\/\n 58<\/jats:sup>\n Co B\n 12<\/jats:sub>\n ratio was estimated at regular intervals for 36-hour periods. Maximum accuracy of isotope measurement on a single specimen was obtained 8-20 hours after isotope dosing.\n <\/jats:p>\n \n The Dicopac investigation is a useful simple screening test in the differential diagnosis of patients with a megaloblastic bone marrow and combined low serum B\n 12<\/jats:sub>\n and folate concentrations. When carried out by the standard technique, the degree of discrimination between normal and abnormal ratios is of limited diagnostic significance in one-third of patients.\n <\/jats:p>","DOI":"10.1136\/jcp.32.3.244","type":"journal-article","created":{"date-parts":[[2007,6,9]],"date-time":"2007-06-09T00:50:46Z","timestamp":1181350246000},"page":"244-250","source":"Crossref","is-referenced-by-count":9,"title":["An evaluation of simultaneously administered free and intrinsic factor bound radioactive cyanocobalamin in the diagnosis of pernicious anaemia in the elderly"],"prefix":"10.1136","volume":"32","author":[{"given":"M. S.","family":"Pathy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Kirkman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. J.","family":"Molloy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1979,3,1]]},"reference":[{"key":"ref_1","first-page":"18","article-title":"Simultaneous free and bound radioactive vitamin B12 urinary excretion test","author":"Bell, T.K.; Bridges, J.M.; Nelson, M.G.","year":"1965","unstructured":"Bell, T. K., Bridges, J. M., and Nelson, M. G. (1965). Simultaneous free and bound radioactive vitamin B12 urinary excretion test. Journal of Clinical Pathology, 18,611-613.","journal-title":"Journal of Clinical Pathology"},{"key":"ref_2","first-page":"135","article-title":"An evaluation of a dual-isotope method for the measurement of vitamin B12 absorption","volume":"14","author":"Briedis, D.; McIntyre, P.A.; Judisch, J.; Wagner, Jr, H.N.","year":"1973","unstructured":"Briedis, D., McIntyre, P. A., Judisch, J., and Wagner, H. N., Jr. (1973). 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Journal of Clinical Pathology, 14, 335-344.","journal-title":"Journal of Clinical Pathology"}],"container-title":["Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jcp.32.3.244","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T09:38:51Z","timestamp":1765705131000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcp.bmj.com\/lookup\/doi\/10.1136\/jcp.32.3.244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1979,3]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[1979,3,1]]},"published-print":{"date-parts":[[1979,3]]}},"alternative-id":["10.1136\/jcp.32.3.244"],"URL":"https:\/\/doi.org\/10.1136\/jcp.32.3.244","relation":{},"ISSN":["0021-9746","1472-4146"],"issn-type":[{"type":"print","value":"0021-9746"},{"type":"electronic","value":"1472-4146"}],"subject":[],"published":{"date-parts":[[1979,3]]}}}