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Pernicious anemia

"Addison's anaemia" redirects here. For the disease affecting the adrenal glands, see Addison's disease.
Pernicious anemia
Other namesVitamin B12 deficiency anemia, Biermer's anemia,[1] Addison's anemia,[2] Addison–Biermer anemia[3]
Micrograph showing nodular enterochromaffin-like cell hyperplasia, as demonstrated with chromogranin A immunostaining, in the body of the stomach. Parietal cells are not readily apparent. These changes are in keeping with autoimmune metaplastic atrophic gastritis, a histologic correlate of vitamin B12 deficiency anemia.
SpecialtyHematology
SymptomsFeeling tired, shortness of breath, pale skin, numbness in the hands and feet, confusion, poor reflexes[4]
Usual onsetAny age, particularly those over 60 years old[1]
CausesNot enough intrinsic factor[5]
Diagnostic methodBlood tests, bone marrow tests[6]
TreatmentVitamin B12 injections[7]
PrognosisWith treatment a normal life[5]
Frequency1 per 1000 people[8]

Pernicious anemia is a disease where not enough red blood cells are produced due to a deficiency of vitamin B12.[5] Those affected often have a gradual onset.[5] The most common initial symptoms are feeling tired and weak.[4] Other symptoms may include shortness of breath, feeling faint, a smooth red tongue, pale skin, chest pain, nausea and vomiting, loss of appetite, heartburn, numbness in the hands and feet, difficulty walking, memory loss, muscle weakness, poor reflexes, blurred vision, clumsiness, depression, and confusion.[4] Without treatment, some of these problems may become permanent.[5]

Pernicious anemia refers to a type of vitamin B12 deficiency anemia that results from lack of intrinsic factor.[5] Lack of intrinsic factor is most commonly due to an autoimmune attack on the cells that create it in the stomach.[9] It can also occur following the surgical removal of all or part of the stomach or small intestine; from an inherited disorder or illnesses that damage the stomach lining.[9] When suspected, diagnosis is made by blood tests initially a complete blood count, and occasionally, bone marrow tests.[6] Blood tests may show fewer but larger red blood cells, low numbers of young red blood cells, low levels of vitamin B12, and antibodies to intrinsic factor.[6] Diagnosis is not always straightforward and can be challenging.[10]

Because pernicious anemia is due to a lack of intrinsic factor, it is not preventable.[11] Pernicious anemia can be treated with injections of vitamin B12.[7] If the symptoms are serious, frequent injections are typically recommended initially.[7] There are not enough studies that pills are effective in improving or eliminating symptoms.[12] Often, treatment may be needed for life.[13]

Pernicious anemia is the most common cause of clinically evident vitamin B12 deficiency worldwide.[14] Pernicious anemia due to autoimmune problems occurs in about one per 1000 people in the US. Among those over the age of 60, about 2% have the condition.[8] It more commonly affects people of northern European descent.[2] Women are more commonly affected than men.[15] With proper treatment, most people live normal lives.[5] Due to a higher risk of stomach cancer, those with pernicious anemia should be checked regularly for this.[13] The first clear description was by Thomas Addison in 1849.[16][17] The term "pernicious" means "deadly", and this term came into use because, before the availability of treatment, the disease was often fatal.[5][18]

  1. ^ a b Andres E, Serraj K (2012). "Optimal management of pernicious anemia". Journal of Blood Medicine. 3: 97–103. doi:10.2147/JBM.S25620. PMC 3441227. PMID 23028239.
  2. ^ a b Professional guide to diseases (9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2009. p. 502. ISBN 978-0-7817-7899-2.
  3. ^ Forbis P (2005). Stedman's medical eponyms (2nd ed.). Baltimore, Md.: Lippincott Williams & Wilkins. p. 6. ISBN 978-0-7817-5443-9.
  4. ^ a b c "What Are the Signs and Symptoms of Pernicious Anemia?". National Heart, Lung, and Blood Institute. April 1, 2011. Archived from the original on 14 March 2016. Retrieved 14 March 2016.
  5. ^ a b c d e f g h "What Is Pernicious Anemia?". National Heart, Lung, and Blood Institute. April 1, 2011. Archived from the original on 14 March 2016. Retrieved 14 March 2016.
  6. ^ a b c "How Is Pernicious Anemia Diagnosed?". National Heart, Lung, and Blood Institute. April 1, 2011. Archived from the original on 14 March 2016. Retrieved 14 March 2016.
  7. ^ a b c "How Is Pernicious Anemia Treated?". National Heart, Lung, and Blood Institute. April 1, 2011. Archived from the original on 14 March 2016. Retrieved 14 March 2016.
  8. ^ a b Li X, Thomsen H, Sundquist K, Sundquist J, Försti A, Hemminki K (2021). "Familial Risks between Pernicious Anemia and Other Autoimmune Diseases in the Population of Sweden". Autoimmune Diseases. 2021: 8815297. doi:10.1155/2021/8815297. PMC 7815416. PMID 33505716.
  9. ^ a b "What Causes Pernicious Anemia?". National Heart, Lung, and Blood Institute. April 1, 2011. Archived from the original on 14 March 2016. Retrieved 14 March 2016.
  10. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
  11. ^ "How Can Pernicious Anemia Be Prevented?". National Heart, Lung, and Blood Institute. April 1, 2011. Archived from the original on 14 March 2016. Retrieved 14 March 2016.
  12. ^ Wolffenbuttel, Bruce H.R.; Wouters, Hanneke J.C.M.; Heiner-Fokkema, M. Rebecca; van der Klauw, Melanie M. (June 2019). "The Many Faces of Cobalamin (Vitamin B12) Deficiency". Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 3 (2): 200–214. doi:10.1016/j.mayocpiqo.2019.03.002. ISSN 2542-4548. PMC 6543499. PMID 31193945.
  13. ^ a b "Living With Pernicious Anemia". National Heart, Lung, and Blood Institute. April 1, 2011. Archived from the original on 14 March 2016. Retrieved 14 March 2016.
  14. ^ Rojas Hernandez, Cristhiam M.; Oo, Thein Hlaing (March 2015). "Advances in mechanisms, diagnosis, and treatment of pernicious anemia". Discovery Medicine. 19 (104): 159–168. ISSN 1944-7930. PMID 25828519.
  15. ^ Greer JP (2009). Wintrobe's clinical hematology (12th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 1157. ISBN 978-0-7817-6507-7. Archived from the original on 2016-03-14.
  16. ^ Wailoo K (1999). "The Corporate "Conquest" of Pernicious Anemia". Drawing blood technology and disease identity in twentieth-century America (Johns Hopkins Paperbacks ed.). Baltimore, Md.: Johns Hopkins University Press. p. Chapter 4. ISBN 978-0-8018-7029-3. Archived from the original on 2016-03-14.
  17. ^ Dictionary of Medicine. Routledge. 2014. p. 404. ISBN 978-1-135-92841-4. Archived from the original on 2016-03-14.
  18. ^ Tamparo C (2016). Diseases of the Human Body. F.A. Davis. p. 295. ISBN 978-0-8036-5791-5. Archived from the original on 2016-03-17.

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