PERNICIOUS ANEMIA

Pernicious Anemia is a type of anemia that occurs due to a lack of

Intrinsic Factor (IF). Intrinsic factor is produced in the stomach and
binds with Vitamin B12 to enable it to be absorbed by the small
intestine. So if there is no Intrinsic factor, vitamin B12 cannot be used
by the body, so RBC's are not going to be produced well. It is called
"pernicious" because long ago, the disease was said to be fatal due to
lack of treatment at that time, but in this age, it is quite treatable.

Epidemiology
It occurs in 0.1% of the general population and 1.9% in people older
than 60 years. It affects both sexes, though women are more affected
than men. It affects mostly people of Northern European origin, I.e,
Scandinavian countries like Norway, Sweden, Finland, etc.

Pathogenesis
The parietal cells of the gastric mucosa in the stomach produce the
intrinsic factor (IF) essential for vitamin B12 absorption. Pernicious
Anemia occurs when these cells experience autoimmune attack. This
attack results to the formation of antibodies which are of three types;

a. Type I: prevent bonding of Intrinsic factor and Vitamin B12.

b. Type II: prevent binding of IF-Vit B12 complex with ileal receptor

c. Type III: target parietal cells.

Pernicious Anemia can also occur when part of the stomach is surgically
removed.
Signs/Symptoms
The most common symptoms are:

 Fatigue
 Shortness of breath
 Pallor
 Headache
 Weight loss
 Glossitis (inflated bloody red tongue)
In more severe cases, the patient may experience neurological
symptoms like;
 Tingling and burning of extremities
 Paraethesia numbness
 Memory loss
The patient could also experience gastrointestinal symptoms
like;
 Nausea
 Vomiting
 Diarrhea
 Constipation
Investigations
a. Vitamin B12 level: The doctor can do a blood test to check
for the Vitamin B12 level, if it is lower than normal, it is a
deficiency of Vitamin B12.
b. IF and parietal cell antibodies: The blood is tested for
antibodies against the Intrinsic Factor and the parietal cells
of the gastric mucosa.
Blood count: This is used in checking for hemoglobin and
hematocrit levels in the blood.
Treatment
a. Vitamin B12 injections like cyanocobalamin can be given
b. Oral doses of Vitamin B12 are given

Some people with pernicious anemia live with and manage it

through their lives. Early diagnosis is important in handling
this disease.