Pernicious Anemia

Background
Originally referred to all megaloblastic anemias

Pernicious means:
◦ Highly destructive

◦ Injurious

◦ Deadly

First described by Dr. Thomas Addison

 Classification
Vitamin B12 deficiency anemia – Intrinsic Factor deficiency anemia

Macrocytic anemia due to megaloblastic dyspoiesis

 Causes
Primarily caused by lack of intrinsic factors

Leads to Vit. B12 deficiency

Intrinsic factors are needed for Vit. B12 absorption

 Causes
Inadequate Diet
Loss of gastric mucosa
Functionally abnormal IF
Insufficient pancreatic enzymes
Ileal dysfunction
Parasitic Infection
Medication
Pathophysiology
Gastric cells are destroyed due to autoimmune disorder
No production of Intrinsic Factors
Vitamin B12 cannot be absorbed in the Ileum
Results in unbalanced cell growth and impaired cell division
Signs and Symptoms
Weight Loss
Tingling or other skin sensations
Tongue Soreness
Fatigue and General weakness
Skin pallor and jaundice (lemon yellow skin)
Neurologic Manifestation
oPsychotic
oPeripheral neuropathy
oPosterior Spinal Column Degeneration
oPyramidal Tract sign
Screening Tests
CBC
Reticulocyte count
WBC manual differential count
Serum Bilirubin
Serum LDH
Confirmatory Tests
Bone Marrow Smear – Reference Confirmatory Test
Serum Cobalamin Assay
Antibodies Assay
Gastric Analysis and Serum Gastrin
Deoxyuridine Suppresion Test
Stool Analysis for parasites
*Schilling Test
Antibodies found in serum of patients
with Pernicious Anemia
oAnti-parietal cell antibodies – reacts with gastric
cells
oAnti-intrinsic factor antibodies- can block or bind
with intrinsic factor or its complex to inhibit
absorption
oThyroid antibodies
Schilling Test
Stage 1 – oral plus IM Vitamin B12
Stage 2 – Vitamin B12 plus Intrinsic Factor
Stage 3 – Vitamin B12 and antibiotics
Stage 4 – Vitamin B12 and pancreatic enzyme
Bone Marrow Smear
Peripheral Blood Smear
 Case Study
A 35 year old woman presents with a tingling sensation in both hands and feet for 2
months. There is also tongue soreness and a slight tinge of yellow in her skin.
A complete blood count is significant for a Hb of 9.3 g/dL, RBC count of 3.1 x 1012 /L, and
a MCV of 126 fL.
The Peripheral Blood Smear demonstrates marked macrocytosis and
anisopoikilocytosis, along with some hypersegmented neutrophils.
Serum Vitamin B12 levels were measured and found at 110 pg/ml
She was subjected to a Schilling Test – Part 1 - low, Part 2 - normal
She is found out to have Pernicious Anemia