Pernicious Anaemia

Pernicious Anaemia

·        Symptoms & signs (due to anaemia or B12 deficiency):

o  SOB/lethargy

o  Sore tongue (glossitis in 50%)

o  Parasthesiae and gait disturbance (peripheral neuropathy), loss of proprioception/reflexes

o  Depression, impaired memory

o  Mild splenomegaly

·        Investigations:

o  Bloods: macrocytic anaemia, leucopenia, hypersegmented neutrophils, ­bilirubin, ¯serum B12

o  Schilling Test: < 10% urinary excretion of 58Co labelled B12, corrected when administered with intrinsic factor

o  Also serum gastrin measurement and endoscopy for gastritis

·        Differential:

o  Dietary (e.g. vegan) or malabsorption (e.g. Crohn‟s) deficiency of B12

o  Chronic H Pylori gastritis

o  8% of pernicious anaemias develop gastric cancer

·        Treatment: iv B12, loading dose then 1 mg every 3 months (watch for folate deficiency initially)