Spurious laboratory alterations in pernicious anemia

The authors report a case of pernicious anemia presenting with normocytosis, “nonthyroidal illness syndrome” (NTIS) and elevated cancer antigen 15.3 (CA 15.3). Megaloblastic anemia is caused by defects in DNA synthesis and typically presents with macrocytosis. One of its causes is low serum vitamin B12 (cobalamin) levels, caused in 20–50% of the cases by a decrease in intrinsic factor due to atrophy of the gastric mucosa and consequently loss of parietal cells − an autoimmune condition known as pernicious anemia.1,2 CA 15.3, a serum tumor marker, is a mucinous antigen of the Mucin 1 (MUC-1) glycoprotein that is expressed by epithelial cells (mainly breast epithelial cells) and erythroid precursors (it is absent in mature erythrocytes).3 Its elevation is mainly associated with breast adenocarcinoma, but it can also be found in other cancers and in some benign diseases.3–5 NTIS is a condition in which there are abnormal thyroid function tests in a patient without thyroid disease due to an

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