1. Immunity relationship
1.1. The most common co-existing autoimmune disease for patients with Pernicious Anemia is Hashimoto's Thyroiditis.
1.2. https:pernicious-anaemia-society.org/symptoms/
1.3. Other Autoimmune diseases pt's with Pernicious Anemia will likely have: Diabetes type 1, Grave's Disease, Multiple Sclerosis, Psoriasis
2. Etiology
2.1. People with Pernicious Anemia produce Intrinsic Factor Antibodies. They attack any intrinsic factor produced by the parietal cells and make them useless. This causes the person to become deficient in Vitamin B-12. Vitamin B-12, along with Folate, are necessary to make healthy, working red blood cells.
2.1.1. People with Pernicious Anemia are unable to absorb Vitamin B-12 from food. Once they receive replacement therapy, they will need to continue for their lifetime.in order to live. There is no cure.
2.1.2. Intrinsic factor antibody test is only 50% accurate.
2.2. Red blood cells transport oxygen by it's Hemoglobin. People without B-12 will make cells called Megloblasts, which are oddly shaped and 65% of people with Pernicious Anemia have enlarged red blood cells. The odd shape of the cells is why oxygen cannot be transported. Low hemoglobin means the red blood cells are unhealthy. .
2.3. More common in women
2.3.1. What is Pernicious Anaemia | Pernicious Anaemia Society
2.4. Familial
2.5. Gilbert, 2017
3. Treatments
3.1. Cobalamin therapy
3.1.1. Persons with neurologic symptoms: IM injections "on alternate days until there is no further improvement" then every 2 months.
3.1.2. Persons without neurologic symptoms IM injections 3 times a week for 2 weeks, then every 2-3 months for life.
3.1.3. Side effects of cobalamin can include itching, rash, chills, fever, hot flashes, and dizziness (Gilbert, 2017).
3.2. Before the late 1940;s, when manufactured Vitamin B-12 was produced, patients ate raw or barely cooked liver or drank liver drinks.
3.3. https:pernicious-anaemia-society.org/treatment/
4. Symptoms / Common Findings
4.1. Gradual, subtle symptoms
4.2. Some patients have a few symptoms, others have nearly all of them.
4.3. A late diagnosis often happens because symptoms are found in other illness.
4.4. Common/early onset: Shortness of Breath, Fatigue, Brain Fog, Clumsiness, Dry skin, Brittle, flaky nails
4.5. Neurological Symptoms: dizzy, fainting, numbness or tingling, burning in legs and feet, vertigo, tinnitus, fibromyalgia, trouble with balance
4.6. Behavioral changes: impatient, irritable, mood swings, depressed
4.7. Oral cavity: Mouth ulcers, swollen tongue, cracked tongue, beefy tongue
4.8. GI symptoms: sudden diarrhea, poor digestion, weight loss, loss of appetite
4.9. https//pernicious-anaemia-society.org/symtoms/
5. Risk factors
5.1. Age
5.1.1. lower levels of Vitamin B-12 are commonly found in 10%-38% of patients (Cadogan, 2010).
5.2. Malabsorbption produced by atrophic gastritis in 60%-70% of cases (Cadogan, 2010).
5.3. Helicobacter pylori
5.4. Use of protein pump inhibitors and/or histamine receptor blocking agents
5.5. Cadogan, 2010
5.6. Can be associated with gastric cancer (Gilbert, 2017).
6. Diagnostic tests
6.1. Tests to identify B12 deficiency
6.1.1. FBC shows MCV (mean corpuscular volume which will show megaloblastosis
6.1.2. Serum B12
6.1.3. Red blood cell folate / serum folate
6.1.4. Intrinsic factor antibody
6.1.4.1. Positive in 40%-60% of patients
6.1.5. Parietal cell antibodies
6.1.5.1. found in 80% of patients
6.1.6. Gilbert, 2017