Pernicious anaemia

Question 1

what is the cause

Answer 1

B12 deficiency

Question 2

pathophysiology?

Answer 2

parietal cells = intrinsic factor
intrinsic factor is essential for b12 absorption in the ileum
autoimmune - antibodies form against parietal cells/intrinsic factor

Question 3

what neurological symptoms can b12 deficiency cause?

Answer 3

peripheral neuropathy - numbness/paraesthesia (pins + needles)

• loss of vibration sense and proprioception
• visal changes
• mood and cognitive changes

Question 4

how do we diagnose pernicious anaemia ?

Answer 4

testing for auto-antibodies

intrinsic factor antibody - first line
gastric parietal cell antibody

Question 5

management of pernicious anaemia ?

Answer 5

oral replacement with cyanocobalamin

Question 6

if oral replacement for pernicious anaemia doesn’t work, what is the next step?
how do you take this medicine?

Answer 6

hydroxycobalamin

3 times weekly for 2 weeks - then every 3 months

Question 7

if a patient also has folate deficiency as well as b12 deficiency what do you do ?

Answer 7

treat b12 first

- giving folic acid when they are b12 deficient can lead to subacute combined degeneration of the cord