Pernicious Anemia
Diagnosis
Evaluation of Symptoms
unexplained anemia, macrocytosis
Unexplained neurologic or psychiatric symptoms
Strict vegan diet or conditions that may interfere with absorption
certain autoimmune disorders such as thyroiditis or vitiligo or taking chronic metformin therapy
gastrointestinal symptoms such as sore tongue, anorexia, or diarrhea
Periodic monitoring of Vitamin B12 levels may be appropriate.
risk factors
living in an environment with lack of access to vitamin b12 rich foods
pathophysiology
absence of intrinsic factor. IF is secreted by gastric parietal cells and complexes with dietary vitamin b12 in the small intestine. The B12- IF complex binds to cell surface receptors in the ileum and is transported across the intestinal mucosa
Congenital IF deficiency is a genetic disorder that demonstrates an autosomal recessive inheritance pattern.
Frequently a component of autoimmune polyendocrinopahty, which is a cluster of autoimmune diseases of the endocrine organs.
comorbidities
Hashimoto thyroidities
Type I Diabetes Mellitus
Addison disease
Primary hypoparathyroidism
Graves Disease
Myasthenia Gravis
Removal of stomach, resection of the ileum and infestation of tape worms.
pregnancy
cancer
hyperthyroidism
chronic infection
use of proton pump inhibitors
slowly developing
mood swings
fatigue, weakness, dizziness
skin appears sallow
blood tests
bone biopsy, aspiration of bone marrow
gastric biopsy
Tests used to diagnose pernicious anemia include moderate to sever megaloblastic anemia, leukopenia with hyper-segmented granulocytes, low levels of serum b12, elevated serum levels of homocysteine and methylmalonic acid, outpouring of reticulocytes and increase in hematocrit level after about 5 days of parenteral administration of vitamin b12.
presence of circulating antibodies against parietal cells and intrinsic factor is also useful in diagnosis
Treatment
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