Vitamin B12 (cobalamin). Antibodies to intrinsic Castle factor, IgG What are the consequences of vitamin B12 deficiency on the formation of red blood cells

External factor

Castle's extrinsic factor is vitamin B12 (cobalamin, or cyanocobalamin), which is found in raw meat, raw liver, yeast, fish, eggs, and milk.

Internal factor

Castle's internal factor (gastromucoprotein) is a complex compound consisting of peptides that are cleaved from pepsinogen when it is converted into pepsin, and mucoids, a secretion secreted by the cells of the gastric mucosa (mucocytes). The mucoid part of the complex protects it from hydrolysis by digestive enzymes and utilization by intestinal bacteria; the protein part determines its physiological activity. The main role of Castle's intrinsic factor is the formation of a labile complex with vitamin B12, which is absorbed by the epithelial cells of the ileum. Absorption is enhanced in the presence of calcium ions, bicarbonates and pancreatic enzymes. In blood plasma, vitamin B12 binds to plasma proteins, forming a protein-B12-vitamin complex, which is deposited in the liver. It enhances the hematopoietic function of the bone marrow, as well as the functions of nervous tissue and glands. -kish. tract.

Violations

The secretion of intrinsic factor Castle may decrease or completely stop when the gastrointestinal tract is damaged. -kish. tract (for example, during an inflammatory process, cancer), when part of the stomach or small intestine is removed, etc. In these cases, the binding and absorption of vitamin B12 is impaired, which leads to the development of B12-deficient megaloblastic, or pernicious, anemia.

see also

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HYPOVITAMINOSIS B12- honey Vitamin B12 (cyanocobalamin, antianemic factor [obsolete], Castle extrinsic factor, protein cyanocobalamin) is a water-soluble vitamin found mainly in foods of animal origin; participates in the biosynthesis of methionine and... ... Directory of diseases

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Castle factor is a special substance (complex proteins, proteins) that, through their combined interaction, stimulate hematopoietic processes in the body. They are named after the American hematologist W.B. Castle. Vitamin B12 is produced in the body through complex biochemical processes at the cellular level. The condition is often diagnosed in young children, adults and elderly patients. With a lack of B12, anemia develops, just like with a lack of iron. The occurrence of pathology is due to the inability to process or absorb folates, vitamin C and vitamin B12, which are responsible for the formation of anemic syndrome. Treatment of the pathology consists of correcting nutrition and intramuscular administration of the vitamin in proportion to the stage of development of B12-deficiency anemia (otherwise known as pernicious anemia).

Characteristics

Castle factor is a complex protein that is transformed into vitamin B12. B vitamins are essential in the production of red blood cells in the blood and the development of the nervous system. Vitamin deficiency causes serious neurological diseases, which without correction can have irreversible consequences for the patient. There are two types of Castle factors:

• external (entered into the body with food);
• internal (produced by the human body).

External B12 accumulates in the liver, milk and meat of animals, which is why a deficiency of this vitamin is so often observed in absolute vegetarians. Plant foods simply do not have B12 because plants are not able to synthesize the vitamin on their own. Intrinsic Castle factor is formed in the mucous tissues of the stomach by special cells that synthesize hydrochloric acid. Some of the proteins in the gastric mucosa are a kind of transport for B12, and its mucoid part protects against the aggressive effects of acids necessary for digestive processes. Complex interactions in the cavity and structures of the stomach produce vitamin B12 and deliver it to the small intestine. When interacting with other substances and cells, B12 is sent into the bloodstream and enters the liver, where it is distributed throughout the body and stored.

Anatomy of the stomach

Important! Vitamin B12 deficiency is a long-term process that can last several years. The first signs often appear as vitamin deficiency increases.

Causes

The causes of vitamin B12 deficiency vary, but they are generally associated with insufficient intake of the body. In addition to natural reasons, there are a number of specific ones:

• hereditary predisposition;
• autoimmune diseases;
• pathologies of liver and kidney structures;
• hormonal diseases (when the consumption of vitamin B12 increases significantly);
• inadequate diets, prolonged fasting;
• adherence to vegetarianism;
• diseases of the gastrointestinal tract;
• diseases of the hematopoietic organs;
• absolute dysfunction of intestinal absorption.

Castle factor structure

There are cases when the Castle factor is in the stomach, but the protein has nothing to contact for further transportation. Such conditions may be associated with a lack of animal products in the diet or with various diseases. The risk group of patients consists of the following persons:

• adherents of plant-based nutrition;
• lovers of hungry diets;
• those who have undergone surgery on the stomach and other organs of the gastrointestinal tract;
• having autoimmune disorders;
• forced to take medications for a long time.

Clinical manifestations

The symptomatic complex with Castle factor deficiency manifests itself in all patients in the same way. At first, the signs appear weakly, but over time the disturbances become persistent. Symptoms are combined into three main groups: anemic signs, dyspeptic, neurological. The predominant manifestations of certain signs are determined by the duration of anemia, which makes up the following general picture:

• general weakness and malaise;
• dizziness, frequent headaches;
• the appearance of spots before the eyes, ringing in the ears;
• fainting, increased heart rate and breathing;
• weight loss, perversion of taste preferences;
• crimson tongue syndrome (due to destruction of the papillae);
• nausea and vomiting;
• stiffness of movement, rapid muscle fatigue;
• convulsive syndrome, nervousness;
• apathy and emotional instability.

The pathology is quite dangerous due to the likelihood of chronic complications. It is not possible to check the presence of Castle factor on your own. The disease can only be determined by a detailed blood test (including antibody levels). If symptoms bother you for a long time against the background of absolute health, you should consult a doctor and undergo a full examination.

Treatment and diagnosis

Differential diagnosis is aimed at excluding iron deficiency anemia, as well as the absence of autoimmune factors. After a thorough examination, doctors plan further therapy.

Diagnostics

Before carrying out therapeutic measures, diagnostics is required, which consists of the following studies:

• study of clinical history;
• studying patient complaints;
• detailed blood test;
• sternum puncture (collection of bone marrow cells).

Consultation with a hematologist is required, and in case of a burdened clinical history of various organs or systems, with other specialists in the treatment profile.

Treatment process

For successful treatment, the patient must remain in the hospital for some time. This will allow for regular monitoring of his condition, monitoring the level of Castle factor and its production. The main drug for the treatment of B12-deficiency anemia is vitamin B12 solution for intramuscular administration. The initial dosage is usually high, after which it is significantly reduced. It all depends on the age of the patient and the severity of vitamin deficiency.

Important! In addition to drug correction, special attention is paid to the patient’s lifestyle: a nutritious diet, exclusion of harmful and toxic substances, physical exercise and daily walks in the fresh air, adherence to the regime (sleep, wakefulness, nutrition).

Prevention

Preventive measures are aimed at creating a complete diet. Products must ensure a complete supply of the vitamin to the body, as well as its maximum absorption. Foods fortified with vitamin B12 include:

• any eggs;
• leafy vegetables with a dark green color;
• grain products;
• any nuts;
• seafood;
• sea ​​fish;
• white meat;
• berries and fruits;
• offal (especially liver).

Main Products

For mild pernicious anemia, nutritional correction, dietary supplements or a special nasal spray are sufficient. In case of severe disorders, intravenous administration of B12 is required. Particularly severe cases require lifelong treatment, which involves weekly administration of a certain dose of the drug subcutaneously or intramuscularly. Timely drug correction will help avoid serious complications in the future.

[13-083 ] Antibodies to intrinsic Castle factor, IgG

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Detection of antibodies to intrinsic Castle factor in the patient’s blood is a test that allows diagnosing the autoimmune cause of vitamin B12 deficiency.

Synonyms Russian

Antibodies to intrinsic Castle factor.

English synonyms

IF Antibody; IF Antibody Type I or Type II; Intrinsic Factor Binding Antibody; Intrinsic Factor Blocking Antibody; Anti-intrinsic Factor.

Research method

Enzyme-linked immunosorbent assay (ELISA).

Units

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

• Do not smoke for 30 minutes before the test.

General information about the study

In medical practice, the determination of antibodies to intrinsic Castle factor in the blood, together with clinical manifestations, is used to diagnose pernicious anemia.

Pernicious anemia is a type of anemia caused by a deficiency of vitamin B12 in the body. The main causes of this disease include atrophic gastritis, an autoimmune pathology in which the body produces antibodies to the internal Castle factor, which promotes the absorption of vitamin B12 in the intestines. Very rarely, pernicious anemia is inherited (congenital pernicious anemia). In adults, symptoms of such anemia usually appear after the age of 30 years, more often after 60 years.

Some people have no symptoms, but most often the disease may be accompanied by the following clinical manifestations: diarrhea or constipation; increased fatigue, decreased performance, dizziness, loss of appetite, pale skin, decreased concentration, shortness of breath during exercise, swollen red tongue, bleeding gums. With a long-term lack of vitamin B12 in the body, the nervous system can be affected: numbness and tingling in the hands and feet, depression, loss of balance, confusion.

The main focus of therapy is to increase the level of vitamin B12 in the body.

What is the research used for?

• Examination of patients with suspected pernicious anemia;
• differential diagnosis with other anemias;
• for preventive examination of healthy people with decreased performance.

When is the study scheduled?

• If diarrhea or constipation is detected; increased fatigue, decreased performance, dizziness, loss of appetite, pale skin, decreased concentration, shortness of breath during exercise, swollen red tongue, bleeding gums, etc.;
• in the presence of Addison's disease, chronic thyroiditis, hyperthyroidism, secondary amenorrhea, type 1 diabetes mellitus, gonadal dysfunction, vitiligo.

What do the results mean?

Reference values: 0 - 6 AU/ml.

If the level of the studied antibodies is within the reference values, it means that the level of intrinsic Castle factor in the body is not reduced due to autoimmune effects, but pernicious anemia may occur.

If the test antibodies are detected in the blood, it means that anemia may be associated with a lack of vitamin B12 in the body.

What can influence the result?

A pronounced comorbid background may reduce the specificity of the method and require targeted differential diagnosis.

Important Notes

• Reasons that increase the likelihood of developing the disease include Addison's disease, chronic thyroiditis, hyperthyroidism, secondary amenorrhea, type 1 diabetes, gonadal dysfunction, and vitiligo.

• Vitamin B12 (cyanocobalamin)
• General blood analysis
• Vitamin B9 (folic acid)
• Vitamin B1 (thiamine)
• Vitamin B5 (pantothenic acid)
• Vitamin B6 (pyridoxine)

Who orders the study?

Hematologist, gastroenterologist, therapist, general practitioner.

Literature

• Bunting RW, Bitzer AM, Kenney RM, et al: Prevalence of intrinsic factor antibodies and vitamin B12 malabsorption in older patients admitted to a rehabilitation hospital. JAGS 1990; 38(7):743-747.
• Waters HM, Dawson DW, Howarth JE, et al: High incidence of type II autoantibodies in pernicious anemia. J Clin Pathol 1993; 46(1):45-47.
• Tietz NW (Ed): Clinical Guide to Laboratory Tests, 3rd ed. W. B. Saunders, Philadelphia, PA, 1995.
• Henry JB: Clinical Diagnosis and Management by Laboratory Methods, 20th ed. Saunders, 2001.
• Lahner E, Annibale B; Pernicious anemia: new insights from a gastroenterological point of view. World J Gastroenterol. 2009 Nov 7;15(41):5121-8.
• Malizia RW, Baumann BM, Chansky ME, et al; Ambulatory dysfunction due to unrecognized pernicious anemia. J Emerg Med. 2010 Apr;38(3):302-7. Epub 2007 Dec 3.
• Turner MR, Talbot K; Functional vitamin B12 deficiency. Pract Neurol. 2009 Feb;9(1):37-41.
• Vlasveld LT; Low cobalamin (vitamin B12) levels in multiple myeloma: a retrospective study. Neth J Med. 2003 Aug;61(8):249-52.

Castle factors, named after the American physiologist and hematologist W.B. Castle, are substances that collectively stimulate hematopoiesis.

External factor

This is vitamin B12, which is found in raw meat, raw liver, yeast, fish, eggs, milk.

Internal factor

Castle's intrinsic factor is a complex compound consisting of peptides that are cleaved from pepsinogen during its conversion into pepsin, and mucoids, a secretion secreted by the cells of the gastric mucosa. The mucoid part of the complex protects it from hydrolysis by digestive enzymes and utilization by intestinal bacteria; the protein part determines its physiological activity. The main role of intrinsic factor Castle is to form a labile complex with vitamin B12, which is absorbed by the epithelial cells of the ileum. Absorption is enhanced in the presence of calcium ions, bicarbonates and pancreatic enzymes. In blood plasma, vitamin B12 binds to plasma proteins, forming a protein-B12-vitamin complex, which is deposited in the liver. It enhances the hematopoietic function of the bone marrow, as well as the functions of the nervous tissue and gastrointestinal tract.

First, let's try to figure out what it is. There are two types: internal and external Castle factors. External is vitamin B12, well known to both doctors and patients. It is produced by bacteria and blue-green algae. Animals accumulate it in the liver, meat, and excrete it in milk. For the growth and development of embryos, a lot of this vitamin is found in the yolks of eggs. But plants cannot synthesize it, so vegetarians usually do not get it.

But our body produces intrinsic factor Castle on its own. It is formed in special cells of the gastric mucosa, the same ones that provide us with hydrochloric acid. Its protein part plays the role of a conductor, and the mucoid part acts as a protector from the digestive action of the aggressive environment of the digestive tract and ubiquitous bacteria. This complex compound helps secrete vitamin B12, combines with it and delivers it to the small intestine. There it finds specially designed cells and is absorbed into the blood along with it. Further, the path of the resulting complex of Castle’s internal and external factors lies in the liver. There it is stored and used as needed.

The nervous system cannot do without vitamin B12, but it is especially needed for the reproduction of new blood cells. The danger of a deficiency of this substance is a slow, imperceptible increase in symptoms.

Possible causes of Castle intrinsic factor deficiency:

• A congenital genetic defect, when for some reason this substance is not produced enough or is completely absent
• Diseases of the stomach in which the work of parietal cells is blocked or their number is sharply reduced (chronic gastritis with atrophy of the mucous membrane or stomach cancer)
• Surgical removal of the stomach for various reasons
• Often additional pathology from the endocrine system, autoimmune diseases are complicated by B12 deficiency anemia

Sometimes enough of it is produced, but the disease still develops. Why could this be?

• Castle has an internal factor, but he has nothing to connect with - a strict vegetarian simply deprives himself of vitamin B12 completely
• The work of the cells of the small intestine, which is responsible for the absorption of the resulting complex, is disrupted
• Complete dysfunction of intestinal absorption, congenital or acquired. This leads to multiple diverticula of the small intestine, some (diphyllobothriasis)
• Condition after intestinal resection

Vitamin B12 and Castle factor deficiency clinic

The most well-known form of the disease associated with a deficiency of these factors is pernicious (megaloblastic) anemia. In addition to the expected pallor, brittle hair and nails, jaundice is associated with increased destruction of red blood cells. The tongue becomes very characteristic and remarkable - completely smooth due to atrophy of the papillae, shiny and bright - varnished. Often quite painful and unpleasant ulcers appear on it - aphthae. Appetite is significantly reduced, and an aversion to meat appears. The liver and spleen may enlarge, and the activity of the heart may be impaired. Of course, in addition to all this, a person feels weakness, loss of strength, and dizziness and darkening of the eyes are often noted.

From the nervous system The signs are even sadder, and everything begins very innocently, and does not make either the patient or his family wary. Initially, weakness appears in the legs, periodically there is a feeling of pins and needles, and reflexes decrease, which are usually determined at an appointment by neurologists. Over time, muscle weakness increases, the functioning of the pelvic organs is disrupted (the activity of the sphincters of the bladder and rectum, impotence develops in men). In some cases, mental abnormalities may appear, from neurosis to severe psychosis with hallucinations, and a progressive decline in intelligence.

Diagnosis and treatment

For correct diagnosis, in addition to the usual peripheral blood test, it is advisable to perform a puncture of the sternum to check bone marrow cells. In addition, you should definitely consult a hematologist. For the safety of the patient and to make the doctor more informative, it is recommended that a complete examination and initiation of treatment be carried out in a hospital.

Once the diagnosis and its possible cause become clear, therapy begins. The main drug for this pathology is vitamin B12 intramuscularly. The dose depends on the severity and severity of symptoms, the degree of deficiency of this important factor. Initially, injections are prescribed daily, then every other day, gradually switching to maintenance administration of the drug once a week.

Naturally, if it is possible to eliminate the internal deficiency of the vitamin in the blood, for example, by diversifying the menu and switching to less strict vegetarianism, removing helminths, this must be done.

Useful video on the topic - “Vitamin B12 - what you eat it with”

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