Pernicious Anaemia

  • autoimmune gastritis

  • reduced intrinsic factor and acid secretion

  • leading to B12 deficiency megaloblastic anaemia

Associated with

  • other organ-specific autoimmune conditions

    • myxoedema

    • thyrotoxicosis

    • vitiligo

    • Addison's disease

    • hypoparathyroidism

  • early greying of hair

  • blue eyes

  • blood group A

  • family history of pernicious anaemia / autoimmune disease

  • 2-3 fold increase in carcinoma of stomach

  • female 1.6x male

  • peak age 60years

Laboratory findings

  • macrocytic anaemia

  • antibodies to intrinsic factor (IF) and / or gastric parietal cells

  • B12 deficiency

  • Schillings test (saved for equivocal cases due to radioactivity)

    • radioactive B12 ingested

    • urinary excretion after 1mg 'flushing dose' as marker of intestinal absorption

    • will be positive when intrinsic factor given at same time as B12

Treatment

  • 1mg hydroxocobalamin IM

    • every 2-3 days for 6 injections

    • 1 every 3 months for life

 

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