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Pernicious Anemia

Addison Anemia

Pernicious anemia (Biermer's anemia, Addison's anemia) is a type of megaloblastic anemia, due to an inability to absorb vitamin B12 (cobalamin). Common symptoms include fatigue, irritability, confusion, depression, gastrointestinal symptoms, weight loss, neuropathic pain and glossitis.


Presentation

The clinical picture of pernicious anemia is indistinguishable from megaloblastic anemia of vitamin B12 deficiency resulting from any etiology.

Symptoms

The onset of symptoms is insidious. The predominant symptoms include the following.

  • Features of anemia: Pallor, weakness, tachycardia and dyspnea are present in all the patients suffering from pernicious anemia.
  • Jaundice: There is mild jaundice caused by the excessive breakdown of hemoglobin due to ineffective erythropoiesis in the bone marrow.
  • Mucosal changes: Angular stomatitis may be present at angle of the mouth. Red, sore tongue (glossitis) may also be present.
  • Polyneuropathy: There may be symmetric loss of sensations in the fingers and toes. Later on, there is difficulty in balance due to loss of sense of vibration and proprioception. In advanced stages, abnormalities of cerebral function also develop that cause progressive weakness and ataxia.

Signs

The signs indicative of pernicious anemia include the following.

  • Signs of anemia are present upon the physical examination of the hands and eyes.
  • Jaundice is seen in the skin and the sclera.
  • Spleenomegaly may be present.
  • There may be low grade fever due to infection or anemia itself.
  • Signs of polyneuropathy are seen upon the examination of the nervous system.
  • Purpurae may be present due to thrombocytopenia.
Splenomegaly
  • Some people with Pernicious Anemia may have an abnormally enlarged liver (hepatomegaly) or spleen (splenomegaly). Other problems involving urinary function may also develop.[rarediseases.org]
  • Hepatomegaly and splenomegaly may be present.[patient.info]
Anemia
  • This article discusses pernicious anemia due to a lack of intrinsic factor and other causes. Overview Pernicious anemia is a type of anemia.[web.archive.org]
  • […] the role of pernicious anemia in autoimmune polyglandular syndrome.[ncbi.nlm.nih.gov]
  • Pernicious anemia (Biermer's anemia, Addison's anemia) is a type of megaloblastic anemia, due to an inability to absorb vitamin B12 (cobalamin).[symptoma.com]
  • People who have pernicious anemia have low reticulocyte counts. Serum folate, iron, and iron-binding capacity tests also can help show whether you have pernicious anemia or another type of anemia.[nhlbi.nih.gov]
Weight Loss
  • Abstract An elderly black man was admitted to our institution with macrocytic anemia, dysphagia, and significant weight loss. Results of an esophagogram were suggestive of achalasia.[ncbi.nlm.nih.gov]
  • Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment[ncbi.nlm.nih.gov]
  • These symptoms include nausea (feeling sick to your stomach) and vomiting, heartburn, abdominal bloating and gas, constipation or diarrhea, loss of appetite, and weight loss. An enlarged liver is another symptom.[web.archive.org]
  • General symptoms Weight loss of 10-15 lb occurs in about 50% of patients and probably is due to anorexia, which is observed in most patients. Low-grade fever occurs in one third of newly diagnosed patients and promptly disappears with treatment.[web.archive.org]
Pallor
  • Abstract Pernicious anemia (PA) is an entity initially described in 1849 as a condition that consisted of pallor, weakness, and progressive health decline.[ncbi.nlm.nih.gov]
  • Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment[ncbi.nlm.nih.gov]
  • PATIENT CONCERNS: A 42-year-old man presented with fatigue, pallor, and sustained abdominal distension that had persisted for 15 days.[ncbi.nlm.nih.gov]
  • Definition of pernicious anemia : a severe megaloblastic anemia that is marked by a progressive decrease in the number of red blood cells and by pallor, weakness, and gastrointestinal and nervous disturbances and is caused by malabsorption of vitamin[merriam-webster.com]
Family History of Anemia
  • He or she also may ask: Whether you've had any stomach or intestinal surgeries Whether you have any digestive disorders, such as celiac disease or Crohn's disease About your diet and any medicines you take Whether you have a family history of anemia or[nhlbi.nih.gov]
Congestive Heart Failure
  • We present the unusual case of vitiligo associated with pernicious anemia in a patient who presented to the hospital because of hyperdynamic congestive heart failure.[ncbi.nlm.nih.gov]
  • Congestive heart failure and coronary insufficiency can occur, most particularly in patients with preexisting heart disease. Gastrointestinal symptoms Approximately 50% of patients have a smooth tongue with loss of papillae.[web.archive.org]
  • Compensatory increased cardiac output results in palpitations, wide pulse pressure, dyspnea, orthopnea, tachycardia, premature beats, and eventually, congestive heart failure.[innvista.com]
Abdominal Pain
  • Our case also underscores the need to (1) consider portomesenteric thrombosis in the differential diagnosis of epigastric abdominal pain, (2) perform a complete thrombotic work-up to elucidate metabolic abnormalities that could be contributing to a pro-thrombotic[ncbi.nlm.nih.gov]
  • Rarely, patients present with severe abdominal pain associated with abdominal rigidity; this has been attributed to spinal cord pathology. Neurologic symptoms Neurologic symptoms can be elicited in patients with pernicious anemia.[web.archive.org]
  • Rarely, patients present with severe abdominal pain associated with abdominal rigidity; this has been attributed to spinal cord pathology.[emedicine.medscape.com]
  • Affected individuals may also have gastrointestinal problems, such as a profound lack of appetite (anorexia), abdominal pain, indigestion, belching, and/or constipation and diarrhea. Weight loss is also common.[rarediseases.org]
  • Other gastrointestinal symptoms, such as abdominal pain or constipation, may occur.[livehealthy.chron.com]
Dyspepsia
  • Less commonly, the disease is suspected to be caused by dyspepsia. PA is frequently associated with autoimmune thyroid disease (40%) and other autoimmune disorders, such as diabetes mellitus (10%), as part of the autoimmune polyendocrine syndrome.[ncbi.nlm.nih.gov]
  • Only 3% of PA patients presented directly to our gastroenterology unit for long-standing dyspepsia, and only 3% were referred from a neurologist.[doi.org]
  • It presents with a number of further common symptoms, including depressive mood, low-grade fevers, diarrhea, dyspepsia, weight loss, neuropathic pain, jaundice, sores at the corner of the mouth (angular cheilitis), a look of exhaustion with pale and dehydrated[en.wikipedia.org]
  • Patients with evidence of vitamin B 12 deficiency and chronic gastrointestinal symptoms such as dyspepsia, recurrent peptic ulcer disease, or diarrhea may warrant evaluation for such entities as Whipple's disease (a rare bacterial infection that impairs[aafp.org]
  • In symptomatic persons, the following are the most common symptoms: Passage of proglottids Abdominal discomfort or dyspepsia Diarrhea Other, less common, symptoms include the following: Fatigue Dizziness Weakness or numbness of extremities (rare) Most[emedicine.com]
Tachycardia
  • Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment[ncbi.nlm.nih.gov]
  • The symptoms may include generalized weakness and fatigue, difficulty breathing (dyspnea), an abnormally rapid heartbeat (tachycardia), and/or chest pains (angina).[rarediseases.org]
  • Features of anemia: Pallor, weakness, tachycardia and dyspnea are present in all the patients suffering from pernicious anemia.[symptoma.com]
  • The symptoms of pernicious anemia may include weakness, fatigue, an upset stomach, an abnormally rapid heartbeat (tachycardia), and/or chest pains.[rarediseases.org]
Sore Mouth
  • Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment[ncbi.nlm.nih.gov]
  • .,” Sotos was researching a book on Abraham Lincoln’s health when he came across a letter written in 1852, which mentions that Mary Lincoln was suffering from a sore mouth.[history.com]
  • Symptoms that can appear include: Pallor Fatigue Diarrhea Sore mouth Bleeding gums Loss of appetite Rapid heart rate Tongue problems Shortness of breath Positive Babinski's sign Impaired sense of smell Loss of deep tendon reflexes Personality or memory[disabled-world.com]
Aphthous Stomatitis
  • AIM: The aim of this report is to present the management of a patient with pernicious anemia afflicted with recurrent aphthous stomatitis (RAS). BACKGROUND: RAS is one of the most common lesions of the oral mucosa.[ncbi.nlm.nih.gov]
Jaundice
  • She was readmitted with jaundice and macrocytic anemia. The diagnosis of pernicious anemia was confirmed by the low level of serum vitamin B12 and the presence of anti-parietal cell antibody and anti-intrinsic factor antibody.[ncbi.nlm.nih.gov]
  • At the age of 81, general fatigue and jaundice appeared concomitantly with severe anemia, with Hb levels at 5.2 g/dl.[ncbi.nlm.nih.gov]
  • Jaundice: There is mild jaundice caused by the excessive breakdown of hemoglobin due to ineffective erythropoiesis in the bone marrow. Mucosal changes: Angular stomatitis may be present at angle of the mouth.[symptoma.com]
  • Symptoms may include vomiting, diarrhea, fatigue, headache, inability to sleep (insomnia), lack of appetite, failure to thrive, a yellow coloration of the skin (jaundice), irritability, and/or a pale complexion.[rarediseases.org]
  • A physician should also be contacted if the tongue becomes slick or smooth or the patient: bruises or tires easily feels ill for more than five days feels weak or out of breath looks pale or jaundiced.[diagnose-me.com]
Hepatomegaly
  • Some people with Pernicious Anemia may have an abnormally enlarged liver (hepatomegaly) or spleen (splenomegaly). Other problems involving urinary function may also develop.[rarediseases.org]
  • Hepatomegaly and splenomegaly may be present.[patient.info]
Acroparesthesia
  • Neurological symptoms may include numbness, tingling, loss of sensation in the arms and/or legs (acroparesthesias).[rarediseases.org]
Tinnitus
  • […] tongue, or a smooth red tongue Substantial weight loss Inability to distinguish the colors yellow and blue Fatigue Paleness Loss of hunger Altered sense of taste Confusion Depression Impaired sense of balance, especially in the dark Ringing in the ears— tinnitus[cancercarewny.com]
  • […] burning), disturbed sense of position, lack of coordination and muscle coordination (ataxia), impaired fine finger movement, positive Babinski’s and Romberg’s signs, light-headedness, altered vision (diplopia, blurred vision), altered taste and hearing (tinnitus[innvista.com]
  • Tinnitus This is extremely common in patients with PA and is probably due to slight nerve damage to the brain. Sensory Impairment Loss of smell, taste, touch Irritability/Frustration/Impatience A general feeling of unease.[pernicious-anaemia-society.org]
Alopecia
  • Alopecia areata occurred 9 years later. 2007 Wiley-Liss, Inc[ncbi.nlm.nih.gov]
  • Abstract A 27-year-old male, who had developed diabetes mellitus type 1 (DMT1) since the age of eighteen and alopecia areata universalis nine months later, attended the outpatient clinics complaining of general fatigue and shortness of breath.[ncbi.nlm.nih.gov]
  • For example, pernicious anemia may occur together with autoimmune thyroid disease, type 1A diabetes mellitus, alopecia, vitiligo, and chronic atrophic gastritis in type III polyglandular autoimmune (PGA) syndrome—one of a rare group of disorders also[emedicine.com]
Purpura
  • Abstract BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a microangiopathic hemolytic anemia that requires emergent treatment with plasma exchange and is one of the most important conditions for which apheresis service professionals are consulted[ncbi.nlm.nih.gov]
  • Purpurae may be present due to thrombocytopenia. The following investigations are helpful in establishing the diagnosis of pernicious anemia. Blood picture: Blood tests demonstrate low hemoglobin levels.[symptoma.com]
Yellow Discoloration of the Skin
  • Enlargement of liver and spleen (hepatosplenomegaly) may also occur, accompanied by yellow discoloration of the skin (jaundice) or pallor. Weakness, heart palpitations, difficulty breathing , as well as pain in the limbs are other possible symptoms.[diagnose-me.com]
  • Enlargement of liver and spleen (hepatosplenomegaly) may also occur, accompanied by yellow discoloration of the skin (jaundice) or pallor. Weakness, heart palpitations, difficulty breathing, as well as pain in the limbs are other possible symptoms.[diagnose-me.com]
Hyperpigmentation
  • Physical examination revealed hypotension and marked hyperpigmentation. Laboratory testing showed hyponatremia, hyperkaliemia and severe normocytic anemia.[ncbi.nlm.nih.gov]
Petechiae
  • Petechiae in the mammillary bodies. WKS, acute lesion. Periaqueductal lesions. WKS, acute lesion. Periaqueductal lesions. WKS, burned out lesion. WKS, burned out lesion. Small brownish mammillary bodies.[neuropathology-web.org]
Psychiatric Manifestation
  • Abstract Pernicious anemia has been associated with various psychiatric manifestations, such as depression, mania and psychosis.[ncbi.nlm.nih.gov]
  • Despite these facts, the need for universal screening in older adults remains a matter of controversy. 3, 4 Clinical Manifestations Vitamin B 12 deficiency is associated with hematologic, neurologic, and psychiatric manifestations ( Table 1 ).[aafp.org]
Visual Hallucination
  • CNS Manifestations Dementia And Acute Psychosis (Megaloblastic Madness) Neuropsychiatric manifestations such as memory loss, depression, hypomania, paranoid psychosis with auditory and visual hallucinations the so called megaloblastic madness have been[ispub.com]
Confusion
  • Severe vitamin B12 deficiency can cause neurological problems, such as confusion, dementia, depression, and memory loss. Other symptoms of vitamin B12 deficiency involve the digestive tract.[web.archive.org]
  • Social Security disability may be available if pernicious anemia or cord degeneration cause confusion or loss of balance.[disabilitysecrets.com]
  • Mental confusion and forgetfulness can also occur with a B-12 deficiency. Pernicious anemia treatment Treatment for pernicious anemia focuses on boosting B-12 levels, which can be done through injections.[belmarrahealth.com]
  • People with untreated pernicious anemia for the long term may be subject to heart failure, heart attacks, strokes, stomach cancer, confusion, and memory loss.[change.org]
Ataxia
  • The outcome was rapidly marked by febrile pancytopenia and ataxia leading to the diagnosis of pernicious anemia.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Medicine, Albert Einstein Medical Center, 5401 Old York Road, Philadelphia, PA 19141, USA. calderaa@einstein.edu Abstract We report the case of a 60-year-old woman with a history of ataxia who sought evaluation after[ncbi.nlm.nih.gov]
  • We describe a case of a young black woman with gradually progressive lower extremity paresthesias, weakness, and ataxia as the primary presenting symptoms of pernicious anemia.[ncbi.nlm.nih.gov]
  • Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment[ncbi.nlm.nih.gov]
Dizziness
  • A low red blood cell count also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale or yellowish skin, and chest pain.[web.archive.org]
  • As the condition worsens, you may experience: weakness and fatigue lightheadedness and dizziness palpitations and rapid heartbeat shortness of breath a sore tongue that has a red, beefy appearance nausea or poor appetite weight loss If your B12 levels[askdoctork.com]
  • Shortness of breath Feeling dizzy Cold hands and feet Chest pain Pale or yellow skin Trouble with balance (for example, struggling to put on your pants or socks while you’re standing) A burning feeling in your legs or feet.[webmd.com]
  • Symptoms of Pernicious Anemia Fatigue and weakness Abdominal cramps Imbalance, changes in reflexes, irritability, confusion and depression Heart palpitations; lightheadedness or dizziness Pallor (may be especially noticeable in the lips, gums, eyelids[healthcommunities.com]
Peripheral Neuropathy
  • Cobalamin deficiency–related neurological impairment can vary in clinical presentation, including acute combined system degeneration, peripheral neuropathy, and psychosis. These neuropathies should be treated more aggressively.[emedicine.medscape.com]
  • Pernicious Anemia Macrocytic anemia, glossitis, peripheral neuropathy, weakness, hyperreflexia, ataxia, and other neurological manifestations characterize classical vitamin B12 (cobalamin) deficiency.[clinlabnavigator.com]
  • Symptoms of PA include: Weakness Headache Chest pain Weight loss In rare cases of PA neurological symptoms can occur, such as: Unsteady gait Stiffness and tightness of the muscles Peripheral neuropathy Progressive lesions on the spinal cord Memory loss[belmarrahealth.com]
  • Vitamin B12 deficiency may present with any combination of the following: macrocytic anemia, glossitis (painful inflammation of the tongue), peripheral neuropathy, weakness, hyperreflexia, ataxia, loss of proprioception, poor coordination, and affective[mayomedicallaboratories.com]
Paresthesia
  • The classic triad of weakness, sore tongue, and paresthesias may be elicited but usually is not the chief symptom complex.[web.archive.org]
  • We describe a case of a young black woman with gradually progressive lower extremity paresthesias, weakness, and ataxia as the primary presenting symptoms of pernicious anemia.[ncbi.nlm.nih.gov]
  • Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment[ncbi.nlm.nih.gov]

Workup

The following investigations are helpful in establishing the diagnosis of pernicious anemia.

  • Blood picture: Blood tests demonstrate low hemoglobin levels. The mean corpuscular volume is usually raised to around 110 to 140 fl. However, it may be normal if there is coexisting thalassemia or iron deficiency. Peripheral blood film shows anisocytosis and poikilocytosis. Neutrophils are characteristically hypersegmented with multilobed nuclei. The reticulocyte count is also reduced.
  • Bone marrow biopsy: The abnormalities seen in bone marrow include large cell size, giant metamyelocytes and marked erythroid hyperplasia [4].
  • Serum vitamin B12: Serum vitamin B12 is usually below 100 pg/ml in symptomatic disease. The normal vitamin B12 level is 150 to 350 pg/ml.
  • Serum lactate dehydrogenase (LDH) and unconjugated bilirubin: The levels of lactate dehydrogenase and unconjugated bilirubin in the serum is also raised [5] [6].
  • Schilling test: This is also known as vitamin B12 absorption test. It is the traditional test to detect decreased oral absorption of vitamin B12 that is characteristic of pernicious anemia. Addition of intrinsic factor causes an increased absorption of vitamin B12 in the patients suffering from pernicious anemia [7] [8].
  • Anti-intrinsic factor antibodies: Antibodies against intrinsic factor are present in around 50% of the cases.
Macrocytic Anemia
  • Macrocytic anemia incidiously appeared in September 1999. An immunological examination detected negative antiparietal cell antibodies and positive anti-intrinsic factor antibodies.[ncbi.nlm.nih.gov]
  • Abstract An elderly black man was admitted to our institution with macrocytic anemia, dysphagia, and significant weight loss. Results of an esophagogram were suggestive of achalasia.[ncbi.nlm.nih.gov]
  • Abstract Pernicious anemia is a macrocytic anemia due to cobalamin deficiency, which is the result of intrinsic factor deficiency.[ncbi.nlm.nih.gov]
  • She was readmitted with jaundice and macrocytic anemia. The diagnosis of pernicious anemia was confirmed by the low level of serum vitamin B12 and the presence of anti-parietal cell antibody and anti-intrinsic factor antibody.[ncbi.nlm.nih.gov]
  • We report the case of a 73-year-old woman with a profound macrocytic anemia, monocytosis and neurologic symptoms. Low cobalamin levels and the presence of anti-intrinsic-factor antibodies definitively established a diagnosis of pernicious anemia.[ncbi.nlm.nih.gov]
Macrocytosis
  • BACKGROUND/PURPOSE: Macrocytosis is defined as having the mean corpuscular volume (MCV) 100 fL. This study assessed hematinic deficiencies and pernicious anemia (PA) in oral mucosal disease patients with macrocytosis.[ncbi.nlm.nih.gov]
  • […] thromboembolism, pseudoleu-kemia, bone marrow failure, bone marrow ring sideroblasts, and neurologic manifestations without anemia or macrocytosis.[ncbi.nlm.nih.gov]
  • We recommend that particular attention be paid to such clinical and laboratory conditions as macrocytosis in administering IFN-alpha therapy for chronic hepatitis C.[ncbi.nlm.nih.gov]
  • However, in our case diagnosis of pernicious anemia was hampered by the absence of typical erythrocytic macrocytosis and hyperchromasia.[ncbi.nlm.nih.gov]
  • Twenty patients (21.1%) had normal blood cell counts; 12 patients (12.6%) had microcytosis with or without anemia and 53 patients (55.8%) macrocytosis with or without anemia.[ncbi.nlm.nih.gov]
Hypochlorhydria
  • Pernicious anemia is associated with atrophic body gastritis, whose diagnostic criteria are based on the histologic evidence of gastric body atrophy associated with hypochlorhydria.[ncbi.nlm.nih.gov]
  • OBJECTIVE: Pernicious anemia (PA) is an autoimmune disease that causes achlorhydria or profound hypochlorhydria.[ncbi.nlm.nih.gov]
  • Hypochlorhydria leads to overgrowth of nitrosamine-producing bacteria with potential carcinogen activity[ 66 ].[doi.org]
  • Etiology Cobalamin deficiency may result from the following: Inadequate dietary intake (ie, vegetarian diet) Atrophy or loss of gastric mucosa (eg, pernicious anemia, gastrectomy, ingestion of caustic material, hypochlorhydria, histamine 2 [H2] blockers[emedicine.com]
Folic Acid Increased
  • Because the demand for folic acid increases among pregnant women and among patients on hemodialysis , risk becomes even higher for these people.[diagnose-me.com]
  • Because the demand for folic acid increases among pregnant women and among patients on hemodialysis, risk becomes even higher for these people.[diagnose-me.com]

Treatment

Therapy for pernicious anemia

Parenteral vitamin B12 therapy: Pernicious anemia is treated by the parenteral administration of vitamin B12 [9]. The parenteral forms of vitamin B12 are cyanocobalamin and hydroxocobalamin. 1000 micrograms of vitamin B12 are injected daily for first week, weekly for first month and then monthly for life. Clinical improvement may occur in as less as 48 hours.

Supportive measures for anemia

Blood transfusion: If the levels of hemoglobin are very low (below 4 g/dl), blood should be transfused in the form of packed cells and furosemide should also be given.

Iron: Ferrous sulphate should be given after treatment with vitamin B12 is started. This is done because in some patients, rapid restoration of blood volume can deplete the iron stores of the body.

Prognosis

With early diagnosis and proper treatment, the prognosis of the patients suffering from pernicious anemia is excellent. However, if the treatment is delayed, anemia and later neurological complications may develop; the latter may be permanent.
There may be an association between pernicious anemia and gastric cancer but it has not yet been proved.

Etiology

Pernicious anemia is caused by the deficiency of intrinsic factor that is produced by the gastric parietal cells. In adults, it usually results from gastrectomy or the autoimmune destruction of parietal cells. Congenital deficiency of intrinsic factor without gastric atrophy may also cause pernicious anemia but is very rare.

Epidemiology

Pernicious anemia is the most common cause of vitamin B12 deficiency. It usually affects people in the late adulthood at the age of 45 to 60 years [1]. The incidence in northern Europe is 1 in 10,000 cases. It is estimated that 0.1% of the general population is affected worldwide. The female to male ratio is 1.6:1 in Europe but equal in the US. It is associated with other autoimmune diseases including thyroid diseases, Addison's disease and vitiligo.

Sex distribution
Age distribution

Pathophysiology

For the proliferation of hematopoietic tissue, DNA is required in large amounts. Since vitamin B12 is necessary for the formation of DNA, its deficiency leads to reduced synthesis of DNA. As a result, there is a delay or arrest of the cell division in the bone marrow. The division of cells is sluggish but cytoplasmic development progresses normally. Large megaloblasts are formed which tend to be destroyed by the bone marrow causing ineffective erythropoiesis.

The absorption of vitamin B12 from the lower ileum is facilitated by gastric intrinsic factor which is released by the parietal cells of the gastric mucosa. Intrinsic factor binds with vitamin B12 and forms a complex that is taken up by the binding sites on the ileal cells. Vitamin B12 is transferred into the cells and absorbed into the blood bound with a carrier protein. In the absence of gastric intrinsic factor, vitamin B12 can not be absorbed and pernicious anemia ultimately develops when the stores of vitamin B12 in the liver are exhausted [2] [3].

Prevention

Primary (congenital) pernicious anemia can not be detected. However, pernicious anemia resulting from secondary causes such as gastrectomy can be prevented by initiating parenteral vitamin B12 substitution soon after the surgery is completed [10].

Summary

Pernicious anemia is the megaloblastic anemia that results from vitamin B12 deficiency as a result of the failure of secretion of intrinsic factor from the gastric parietal cells. It accounts for 30-50% of all cases of megaloblastic anemia due to vitamin deficiency.

Patient Information

Pernicious anemia is caused because of the deficiency of vitamin B12 due to poor absorption from the intestine. Normal blood cells can not form in the absence of vitamin B12. Vitamin B12 is administered by injections for life in all the patients suffering from pernicious anemia. The outcome of this treatment is excellent.

References

Article

  1. Andres E, Vogel T, Federici L, Zimmer J, Ciobanu E, Kaltenbach G. Cobalamin deficiency in elderly patients: a personal view. Current gerontology and geriatrics research. 2008:848267.
  2. Horanyi M, Sarfy E. [Pathogenesis of pernicious anemia]. Orvosi hetilap. Jan 21 1973;114(3):143-145.
  3. Horanyi M, Sarfy E. [Current data on the pathogenesis of pernicious anemia and its treatment with duodenal intrinsic factor]. Orvosi hetilap. Oct 26 1975;116(43):2538-2540.
  4. Macukanovic-Golubovic L, Rancic G, Milenovic M, Marjanovic G, Vojvodic S, Golubovic Z. [Morphometrical analysis of bone marrow metamyelocyte in pernicious anemia]. Medicinski pregled. Nov-Dec 2008;61(11-12):562-565.
  5. Weinreich J, Kustner W. [Lactate dehydrogenase and its isoenzymes in pernicious anemia]. Die Medizinische Welt. Sep 24 1966;39:2050-2053.
  6. Myhrman G. [Determination of lactate dehydrogenase as an aid in the diagnosis of pernicious anemia]. Lakartidningen. Oct 5 1966;63(40):3734-3735.
  7. Fairbanks VF, Wahner HW, Phyliky RL. Tests for pernicious anemia: the "Schilling test". Mayo Clinic proceedings. Aug 1983;58(8):541-544.
  8. The schilling test for pernicious anemia. South Dakota journal of medicine. Mar 1967;20(3):50.
  9. Andres E, Serraj K. Optimal management of pernicious anemia. Journal of blood medicine. 2012;3:97-103.
  10. De Paz R, Hernandez-Navarro F. [Management, prevention and control of pernicious anemia]. Nutricion hospitalaria. Nov-Dec 2005;20(6):433-435.

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Last updated: 2018-06-22 07:07