Could it be that microcytic iron deficiency anemia and macrocytic pernicious anemia have a common underlying etiology?
In this issue of Blood Hershko and colleagues provocatively link some cases of both disorders to Helicobacter pylori associated gastritis. Helicobacter pylori, the spiral Gram-negative bacillus unrecognized a quarter-century ago,1 now seems to be popping up everywhere. Its cover broken, H pylori is now incriminated in peptic ulcers, gastric carcinoma, and mucosa-associated lymphoid tissue (MALT) lymphomas. In the limelight of this year’s Nobel Prize for Physiology and Medicine and with a journal named for and dedicated to its study, it appears that the previously cryptic pathogen is perhaps also responsible for some part of the global burden of anemia. Hershko and colleagues, in this issue of Blood, present circumstantial but compelling evidence derived from a cohort of patients with atrophic gastritis and marked hypergastrinemia that strongly implicates prior H pylori infection as a possible trigger of autoimmune gastritis in individuals so predisposed. Exactly how this occurs is not
