Pernicious Anaemia Flashcards
What is pernicious anaemia the most common cause of?
Vitamin B12 deficiency
What type of condition is pernicious anaemia?
Autoimmune disease which affects the gastric mucosa
Who is most commonly affected by pernicious anaemia?
Middle aged women
What is pernicious anaemia associated with?
Other autoimmune conditions
What autoimmune conditions is pernicious anaemia associated with?
Thyroid disease Type 1 diabetes mellitus Addison's Rheumatoid Vitiligo
What blood group is most commonly affected by pernicious anaemia?
Blood Group A
What is the cause of pernicious anaemia?
Antibodies form against the parietal cells or intrinsic factor.
A lack of intrinsic factor prevents the absorption of vitamin B12
The patient becomes vitamin B12 deficient.
How does pernicious anaemia present?
Anaemia Features
Neurological features
What anaemia features does pernicious anaemia present with?
- lethargy
- pallor
- dyspnoea (SOB)
What neurological features of pernicious anaemia?
- peripheral neuropathy
- subacute combined degeneration of the spinal cord
- neuropsychiatric features
What neuropsychiatric symptoms can a patient with pernicious anaemia present with?
Memory loss Poor concentration Confusion Depression Irritabiltiy
What are other possible features of pernicious anaemia?
- mild jaundice: combined with pallor results in a ‘lemon tinge’
- glossitis → sore tongue
How can someone with pernicious anaemia look?
May have a yellow tinge to their skin due to pallor and jaundice
How does peripheral neuropathy present?
‘Pins and needles’, numbness
Symmetrical and affects the legs more than the arms
How can subacute combined degeneration of the spinal cord present?
Progressive weakness
Ataxia
Paresthesias
May progress to spasticity and paraplegia
What is the first line investigation for pernicious anaemia?
Test for anti-intrinsic factor antibody
What can you also test for but it isn’t as useful?
Gastric parietal cell antibody
What is the management of pernicious anaemia?
Intramuscular Vitamin B12 replacement
1 mg of IM hydroxocobalamin
If the patient doesn’t have neurological symptoms, how often do yo give them Intramuscular vitamin B12 injections?
3 injections per week for 2 weeks
Followed by 3 monthly treatment of vitamin B12 injections
If the patient has neurological symptoms, how often do yo give them Intramuscular vitamin B12 injections?
More regularly
What might also be required in the management of pernicious anaemia?
Folic acid supplement
What is there an increased risk of with pernicious anaemia?
Gastric cancer
What might be seen on a FBC in someone with pernicious anaemia?
hypersegmented polymorphs on blood film
low WCC and platelets may also be seen
What form of anaemia occurs in someone with pernicious anaemia?
Macrocytic anaemia
