Pernicious Anaemia Flashcards

1
Q

What is pernicious anaemia the most common cause of?

A

Vitamin B12 deficiency

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2
Q

What type of condition is pernicious anaemia?

A

Autoimmune disease which affects the gastric mucosa

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3
Q

Who is most commonly affected by pernicious anaemia?

A

Middle aged women

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4
Q

What is pernicious anaemia associated with?

A

Other autoimmune conditions

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5
Q

What autoimmune conditions is pernicious anaemia associated with?

A
Thyroid disease
Type 1 diabetes mellitus
Addison's
Rheumatoid 
Vitiligo
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6
Q

What blood group is most commonly affected by pernicious anaemia?

A

Blood Group A

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7
Q

What is the cause of pernicious anaemia?

A

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.

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8
Q

How does pernicious anaemia present?

A

Anaemia Features

Neurological features

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9
Q

What anaemia features does pernicious anaemia present with?

A
  • lethargy
  • pallor
  • dyspnoea (SOB)
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10
Q

What neurological features of pernicious anaemia?

A
  • peripheral neuropathy
  • subacute combined degeneration of the spinal cord
  • neuropsychiatric features
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11
Q

What neuropsychiatric symptoms can a patient with pernicious anaemia present with?

A
Memory loss
Poor concentration
Confusion
Depression
Irritabiltiy
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12
Q

What are other possible features of pernicious anaemia?

A
  • mild jaundice: combined with pallor results in a ‘lemon tinge’
  • glossitis → sore tongue
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13
Q

How can someone with pernicious anaemia look?

A

May have a yellow tinge to their skin due to pallor and jaundice

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14
Q

How does peripheral neuropathy present?

A

‘Pins and needles’, numbness

Symmetrical and affects the legs more than the arms

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15
Q

How can subacute combined degeneration of the spinal cord present?

A

Progressive weakness
Ataxia
Paresthesias
May progress to spasticity and paraplegia

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16
Q

What is the first line investigation for pernicious anaemia?

A

Test for anti-intrinsic factor antibody

17
Q

What can you also test for but it isn’t as useful?

A

Gastric parietal cell antibody

18
Q

What is the management of pernicious anaemia?

A

Intramuscular Vitamin B12 replacement
1 mg of IM hydroxocobalamin

19
Q

If the patient doesn’t have neurological symptoms, how often do yo give them Intramuscular vitamin B12 injections?

A

3 injections per week for 2 weeks

Followed by 3 monthly treatment of vitamin B12 injections

20
Q

If the patient has neurological symptoms, how often do yo give them Intramuscular vitamin B12 injections?

A

More regularly

21
Q

What might also be required in the management of pernicious anaemia?

A

Folic acid supplement

22
Q

What is there an increased risk of with pernicious anaemia?

A

Gastric cancer

23
Q

What might be seen on a FBC in someone with pernicious anaemia?

A

hypersegmented polymorphs on blood film

low WCC and platelets may also be seen

24
Q

What form of anaemia occurs in someone with pernicious anaemia?

A

Macrocytic anaemia