[Biermer's disease without anemia, nor megaloblastosis. Value of the study of antibodies, vitamin assays, and the dU suppression test for the early diagnosis].

In two patients, a diagnosis of pernicious anemia was made without anemia, megaloblastosis and even macrocytosis. The diagnosis of pernicious anemia was suggested by the autoimmune abnormalities which are frequently associated with this disease: goitre with anti-thyroid and anti parietal cell antibodies, and besides this, idiopathic thrombocytopenic purpura in the first patient, vitiligo in the second. The morphological abnormalities were limited to slight macrocytosis in the first patient and to hypersegmentation of polymorphonuclear leucocyte in both. Vitamin B12 deficiency was demonstrated by serum assay as well as deoxyuridine suppression test ("dU suppression"). The diagnosis was confirmed by demonstration of atrophic gastritis, failure of secretion of Intrinsic Factor and Schilling test. These observations show that the Addison-Biermer disease can be detected early in persons at high risk by looking for vitamin B12 deficiency and specific antibodies.