Pernicious anaemia – Symptoms, Causes, Diagnosis, and Treatments

Introduction

Pernicious Anaemia can occur when red blood cells are not produced enough due to the lack of Vitamin B12. The lack of Vitamin B12 can be due to dietary deficiency of the vitamin or due to decreased absorption of the vitamin from the gastrointestinal tract. In pernicious anaemia, impaired absorption is due to the lack of Intrinsic Factor (IF).

Intrinsic factor is a protein that binds with Vitamin B12, enabling its absorption in the intestine. Decreased production of this protein leads to Pernicious anaemia.  

Symptoms of Pernicious anaemia

Common symptoms include

• Tiredness
• Lethargy
• Headaches  
• Palpitations
• Weight loss
• Pale skin
• Muscular pain and generalised body pain
• Hair fall
• Menstrual irregularity
• Numbness in arms and legs
• Memory impairment
• Depression and Psychosis

Causes

Pernicious anaemia can be autoimmune or hereditary.

Autoimmune disease is due to autoantibodies directed against intrinsic factors and parietal cells in the stomach.  

The two types of autoantibodies identified in Pernicious anaemia are:

• Intrinsic factor antibodies (IFA) and  
• Parietal cell antibodies (PCA).

Diseases associated with Pernicious anaemia include

• Type I Diabetes Mellites,  
• Addisons disease (Adrenal gland-related disorder),  
• Graves’s disease (thyroid gland-related disorder) and  
• Hypoparathyroidism. (Parathyroids are four small glands found close to the thyroid gland and have an important function in maintaining the bone mineral density in blood and bones).

Diagnostic tests

The following blood investigations are beneficial in the diagnosis of Pernicious anaemia.

• Vitamin B12 level
• Complete Blood Count
• Reticulocyte count
• Lactate dehydrogenase levels
• Serum bilirubin level
• Methylmalonic acid levels: High levels are seen in vitamin B12 deficiency patients.
• Homocysteine level: High levels can occur due to lack of vitamin B12.
• Upper endoscopy: The test is an endoscopic evaluation done to look for signs of degeneration or wasting away of the lining of your stomach.

Treatment

Treatment involves supplementation of Vitamin B12 in the form of injections or tablets along with a diet rich in iron, vitamin B12 and vitamin C. Patients with Pernicious anaemia may probably require Vitamin B12 supplements throughout their lives.  

Conclusion 

Megaloblastic anaemia, or Pernicious anaemia (PA), is caused by a lack of vitamin B12 and intrinsic factors. Vitamin B12 injections or tablets are typically effective treatments for Pernicious anaemia.  

A doctor may advise starting with injections in case of severe Pernicious anaemia. Until the level of vitamin B12 in the blood rises, injections are often administered every day or every week into a muscle. Pernicious anaemia patients can heal, feel well and lead regular lives with the proper care and early treatment.

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