{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:25:48Z","timestamp":1787315148352,"version":"build-2736575974"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T00:00:00Z","timestamp":1573776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Autoimmune atrophic gastritis (AAG) leads to iron and\/or vitamin B12 malabsorption, with subsequent haematological alterations which could represent the sole clinical manifestation. We aimed to assess patterns of anaemia and micronutrient deficiencies in patients with AAG at the time of diagnosis. Methods: Observational, multicentre, cross-sectional study including consecutive adult patients diagnosed with AAG within the last ten years. Cell blood count, red cell distribution width, serum vitamin B12, and ferritin were collected. Multivariate analysis for predictive factors of anaemia was computed. Results: 654 AAG patients (mean age 59.2 \u00b1 13.8 years, female (F): male (M) ratio = 2.3:1) were included. Anaemia was present in 316 patients (48.3%; mean age 60.1 \u00b1 15.8 years, F:M ratio = 2.3:1). Pernicious anaemia (132\/316 cases, 41.7%) was more common in males (27.1% versus 12.4%; p = 0.001) and in older patients (63.0 \u00b1 14.6 versus 58.9 \u00b1 14.9 years; p = 0.014), while iron deficiency anaemia (112\/316 cases, 35.4%) was more common in females (16.9% versus 10.0%; p = 0.039) and in younger patients (56.8 \u00b1 16.6 versus 60.2 \u00b1 14.6 years; p = 0.043). The prevalence of iron deficiency was equally distributed between anaemic and non-anaemic patients (p = 0.9). Anisocytosis (odds ratio: 10.65, 95% confidence interval: 6.13\u201318.50, p &lt; 0.0001) was independently associated with anaemia. Conclusions: Anaemia is a common manifestation in AAG patients, mostly due to micronutrient deficiencies. Scant haematologic alterations and micronutrient deficiencies may precede overt anaemia.<\/jats:p>","DOI":"10.3390\/jcm8111992","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T11:24:32Z","timestamp":1573817072000},"page":"1992","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Cell Blood Count Alterations and Patterns of Anaemia in Autoimmune Atrophic Gastritis at Diagnosis: A Multicentre Study"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6654-4911","authenticated-orcid":false,"given":"Marco Vincenzo","family":"Lenti","sequence":"first","affiliation":[{"name":"First Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith","family":"Lahner","sequence":"additional","affiliation":[{"name":"Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant\u2019Andrea Hospital, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2796-9765","authenticated-orcid":false,"given":"Gaetano","family":"Bergamaschi","sequence":"additional","affiliation":[{"name":"First Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Miceli","sequence":"additional","affiliation":[{"name":"First Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Conti","sequence":"additional","affiliation":[{"name":"Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant\u2019Andrea Hospital, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3214-8192","authenticated-orcid":false,"given":"Sara","family":"Massironi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, IRCCS Ca\u2019 Granda Foundation, University of Milan, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1507-6513","authenticated-orcid":false,"given":"Sara","family":"Cococcia","sequence":"additional","affiliation":[{"name":"First Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Zilli","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, IRCCS Ca\u2019 Granda Foundation, University of Milan, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Caprioli","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, IRCCS Ca\u2019 Granda Foundation, University of Milan, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Vecchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, IRCCS Ca\u2019 Granda Foundation, University of Milan, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Maiero","sequence":"additional","affiliation":[{"name":"Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2020-222X","authenticated-orcid":false,"given":"Renato","family":"Cannizzaro","sequence":"additional","affiliation":[{"name":"Oncological Gastroenterology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gino Roberto","family":"Corazza","sequence":"additional","affiliation":[{"name":"First Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9120-5957","authenticated-orcid":false,"given":"Bruno","family":"Annibale","sequence":"additional","affiliation":[{"name":"Department of Surgical-Medical Sciences and Translational Medicine, Digestive and Liver Disease Unit, Sant\u2019Andrea Hospital, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0302-8645","authenticated-orcid":false,"given":"Antonio","family":"Di Sabatino","sequence":"additional","affiliation":[{"name":"First Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/nrgastro.2013.101","article-title":"Autoimmune atrophic gastritis: Pathogenesis, pathology and management","volume":"10","author":"Neumann","year":"2013","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.autrev.2015.08.004","article-title":"New insights into immune mechanisms underlying autoimmune diseases of the gastrointestinal tract","volume":"14","author":"Lenti","year":"2015","journal-title":"Autoimmun. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1001\/archinte.1996.00040041097008","article-title":"Prevalence of undiagnosed pernicious anemia in the elderly","volume":"156","author":"Carmel","year":"1996","journal-title":"Arch. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.cgh.2012.02.018","article-title":"Common features of patients with autoimmune atrophic gastritis","volume":"10","author":"Miceli","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.autrev.2018.08.011","article-title":"The changing face of chronic autoimmune atrophic gastritis: An updated comprehensive perspective","volume":"18","author":"Massironi","year":"2019","journal-title":"Autoimmun. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1182\/blood-2005-09-3534","article-title":"Variable hematologic presentation of autoimmune gastritis: Age-related progression from iron deficiency to cobalamin depletion","volume":"107","author":"Hershko","year":"2006","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17040","DOI":"10.1038\/nrdp.2017.40","article-title":"Vitamin B12 deficiency","volume":"3","author":"Green","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/bjh.15254","article-title":"Pathogenesis, diagnosis and treatment of anaemia in immune-mediated gastrointestinal disorders","volume":"182","author":"Bergamaschi","year":"2018","journal-title":"Br. J. Haematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1056\/NEJM199711133372007","article-title":"Pernicious anemia","volume":"337","author":"Toh","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5121","DOI":"10.3748\/wjg.15.5121","article-title":"Pernicious anemia: New insights from a gastroenterological point of view","volume":"15","author":"Lahner","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3109\/00365529109025032","article-title":"H+,K+-ATPase antibodies in autoimmune gastritis: Observations on the development of pernicious anemia","volume":"26","author":"Burman","year":"1991","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1038\/ajg.2009.231","article-title":"Reassessment of intrinsic factor and parietal cell autoantibodies in atrophic gastritis with respect to cobalamin deficiency","volume":"104","author":"Lahner","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.dld.2015.01.147","article-title":"Single nucleotide polymorphisms related to vitamin B12 serum levels in autoimmune gastritis patients with or without pernicious anaemia","volume":"47","author":"Lahner","year":"2015","journal-title":"Dig. Liver Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1080\/00365521.2016.1236397","article-title":"Autoimmune metaplastic atrophic gastritis in chinese: A study of 320 patients at a large tertiary medical center","volume":"52","author":"Zhang","year":"2017","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1111\/ggi.12832","article-title":"Differences between older and young patients with autoimmune gastritis","volume":"17","author":"Kalkan","year":"2017","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e5784","DOI":"10.1097\/MD.0000000000005784","article-title":"Upper gastrointestinal symptoms in autoimmune gastritis: A cross-sectional study","volume":"96","author":"Carabotti","year":"2017","journal-title":"Medicine (Baltim.)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1080\/00365521.2017.1288758","article-title":"Autoimmune gastritis: Relationships with anemia and Helicobacter pylori status","volume":"52","author":"Villanacci","year":"2017","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/apt.15317","article-title":"Determinants of diagnostic delay in autoimmune atrophic gastritis","volume":"50","author":"Lenti","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s11739-018-1823-0","article-title":"Infertility and recurrent miscarriage in a patient with autoimmune atrophic gastritis","volume":"13","author":"Lenti","year":"2018","journal-title":"Intern. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1097\/00000478-199610000-00001","article-title":"Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994","volume":"20","author":"Dixon","year":"1996","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1080\/00365521.2016.1275771","article-title":"The challenging diagnosis of autoimmune atrophic gastritis","volume":"52","author":"Lenti","year":"2017","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/j.dld.2017.06.010","article-title":"Clinical usefulness of serum antibodies as biomarkers of gastrointestinal and liver diseases","volume":"49","author":"Biagi","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.autrev.2010.08.006","article-title":"Autoantibodies to parietal cells as predictors of atrophic body gastritis: A five-year prospective study in patients with autoimmune thyroid diseases","volume":"10","author":"Tozzoli","year":"2010","journal-title":"Autoimmun. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1136\/gut.2006.106666","article-title":"Gastritis staging in clinical practice: The OLGA staging system","volume":"56","author":"Rugge","year":"2007","journal-title":"Gut"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.gie.2009.12.029","article-title":"The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis","volume":"71","author":"Capelle","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1007\/s12026-016-8841-7","article-title":"Pathophysiology and laboratory diagnosis of pernicious anemia","volume":"65","author":"Toh","year":"2017","journal-title":"Immunol. Res."},{"key":"ref_27","unstructured":"WHO (2011). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Vitamin and Mineral Nutrition Information System, World Health Organization. WHO\/NMH\/NHD\/MNM\/11.1."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1182\/blood-2013-10-512624","article-title":"How I treat unexplained refractory iron deficiency anemia","volume":"123","author":"Hershko","year":"2014","journal-title":"Blood"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.3324\/haematol.13255","article-title":"Anemia of chronic disease and defective erythropoietin production in patients with celiac disease","volume":"93","author":"Bergamaschi","year":"2008","journal-title":"Haematologica"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"199","DOI":"10.3324\/haematol.2009.009985","article-title":"Prevalence and pathogenesis of anemia in inflammatory bowel disease. Influence of anti-tumor necrosis factor-alpha treatment","volume":"95","author":"Bergamaschi","year":"2010","journal-title":"Haematologica"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/MCG.0000000000000101","article-title":"A laboratory score in the diagnosis of autoimmune atrophic gastritis: A prospective study","volume":"49","author":"Miceli","year":"2015","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S0002-9343(01)00883-X","article-title":"Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms","volume":"111","author":"Annibale","year":"2001","journal-title":"Am. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1111\/apt.15540","article-title":"Natural history of autoimmune atrophic gastritis: A prospective, single-institution, long-term experience","volume":"50","author":"Miceli","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lahner, E., Zagari, R.M., Zullo, A., Di Sabatino, A., Meggio, A., Cesaro, P., Lenti, M.V., Annibale, B., and Corazza, G.R. (2019). Chronic atrophic gastritis: Natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists (AIGO), the Italian Society of Digestive Endoscopy (SIED), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Internal Medicine (SIMI). Dig. Liver Dis.","DOI":"10.1016\/j.dld.2019.09.016"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3084","DOI":"10.1111\/j.1572-0241.1999.03084.x","article-title":"Iron-deficiency anemia in premenopausal women: Why not consider atrophic body gastritis and Helicobacter pylori role?","volume":"10","author":"Capurso","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1001\/archinternmed.2009.11","article-title":"Red blood cell distribution width and the risk of death in middle-aged and older adults","volume":"169","author":"Patel","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"De Re, V., Repetto, O., De Zorzi, M., Casarotto, M., Tedeschi, M., Giuffrida, P., Lenti, M.V., Magris, R., Miolo, G., and Mazzon, C. (2019). Polymorphism in toll-like receptors and Helicobacter pylori motility in autoimmune atrophic gastritis and gastric cancer. Cancers, 11.","DOI":"10.3390\/cancers11050648"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/11\/1992\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:34:46Z","timestamp":1760189686000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/11\/1992"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,15]]},"references-count":37,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["jcm8111992"],"URL":"https:\/\/doi.org\/10.3390\/jcm8111992","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,15]]}}}