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Schiling Evaluation of Permicious Anemia: Current Status

Albert Einstein College of Medicine, Bronx, New York

Correspondence: For reprints contact L. Rao Chervu, PhD, Dept. of Nuclear Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.

ABSTRACT

The Schilling examination remains a popular means of evaluating in vivo absorption of vitamin B₁₂. When absorption is abnormally low, the test may be repeated with addition of exogenous intrinsic factor (IF) in order to correct the IF deficiency that characterizes pernicious anemia. A dual-isotope variation provides a means of performing both stages of the test simultaneously, thereby speeding up the test and reducing dependence on complete urine collection. The dual-tracer test depends on no exchange of B₁₂ moieties on the IF molecule. In vitro studies suggest that his exchange does take place, in a manner dependent on time, temperature, and pH. Furthermore, in vivo studies indicate that, when administered simultaneously, the absorption of unbound B₁₂ is elevated, and IF-bound B₁₂ is reduced, in pernicious-anemia patients, relative to the classic two-stage examination. A number of clinical studies indicate significant difficulty in resolving clinical diagnoses with the dual-tracer test. The potential weaknesses of the test discussed herein can be overcome by temporally separating the administration of the two B₁₂doses and by treating secondary malabsorption where it exists. An algorithm is offered for selecting the most suitable variation of the Schilling test to improve the accuracy of test results and the ease of performance.

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