Pernicious anemia is a type of anemia associated with impaired gastric absorption of vitamin B12, which is essential for red blood cell hemoglobin production. Because vitamin B12 is not made in the body in sufficient amounts, it must be absorbed from foods such as meat and eggs. In pernicious anemia, the inability to absorb vitamin B12 is due to the absence of a protein normally made in the stomach called intrinsic factor. It is more common in individuals with other autoimmune glandular deficiencies, including hypothyroidism and thyroiditis.
Pernicious anemia may also be seen in individuals who have had a large part of the stomach removed, which results in a loss of the cells that make intrinsic factor.Risk: Pernicious anemia occurs most often in older individuals and those of northern European descent. Individuals of English, Irish, Scottish, or Scandinavian origin have the highest risk. Females and males are equally affected in the US, although individuals from England, Scandinavia, and Africa show a female-to-male predominance ratio of 1.5 to 1 (Conrad).
The average age of onset is 40 to 70 years; there is a genetic predisposition for pernicious anemia (Conrad). Incidence and Prevalence: The prevalence of pernicious anemia is nearly 2% of individuals over 60 years of age (Hart). |
Source: Medical Disability Advisor
History: Individuals with pernicious anemia, like those with other anemias, may have nonspecific symptoms such as fatigue, dizziness, shortness of breath, and decreased exercise capacity. Symptoms specific to pernicious anemia include a smooth, sore tongue (glossitis), numbness and tingling of the hands and feet (neuropathy), weakness, trouble with coordination and balance (ataxia), memory disturbances, and depression. Physical exam: Physical features of pernicious anemia are those of vitamin B12 deficiency, including a smooth, "beefy red" tongue, an abnormal "broad-based" gait, imbalance, and a loss of vibration and position sense. Nonspecific features of the anemia may include pale skin and rapid respiratory and heart rates even at rest. Tests: A complete blood count (CBC) shows low numbers of large red blood cells (macrocytic anemia) and sometimes low numbers of platelets and large white blood cells. The vitamin B12 level in the blood is low. Antibodies against the stomach cells (parietal cells) that make the intrinsic factor are almost always present. A bone marrow biopsy will show large numbers of large, immature red blood cells (megaloblastic erythroid hyperplasia). If a vitamin B12 deficiency is established, a Schilling test may help confirm the etiology. |
Source: Medical Disability Advisor
Pernicious anemia is treated with regular injections of vitamin B12. Treatment is lifelong because the absorption defect itself cannot be corrected.
Pernicious anemia may also be treated with high oral doses of vitamin B12 with some success. |
Source: Medical Disability Advisor
| If diagnosed early, most individuals see a rapid improvement in symptoms once treatment begins. However, neurologic symptoms may take months to improve, or they may progress and become permanent if the disease remains untreated for a long period of time. |
Source: Medical Disability Advisor
There is an increased risk of developing stomach polyps and stomach cancer with pernicious anemia. It is also associated with other autoimmune disorders such as thyroid disease, gland insufficiency, and loss of skin pigment (vitiligo). Nonspecific complications of severe anemia include chest pain (angina pectoris) and congestive heart failure, especially in individuals with heart disease.
Women older than 65 years of age with pernicious anemia are twice as likely to sustain hip and spine fractures and are nearly 3 times as likely to sustain wrist fractures (Stone 1217). |
Source: Medical Disability Advisor
Individuals with pernicious anemia may require a reduction in physical activity until the condition is adequately treated. Initially, the individual requires sufficient time off to receive weekly vitamin B12 injections, usually for about 6 weeks, and then proceeds to injections once a month.
If neurologic complications occur, individuals may require more sedentary work. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have a history that would place him/her at risk for developing pernicious anemia? What is individual's ethnic background? Has individual had a large part of the stomach removed?
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Were appropriate diagnostic tests done (CBC, serum B12 levels, bone marrow biopsy or Schilling test) to confirm the diagnosis and underlying cause?
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Have other conditions been ruled out (e.g., folic acid deficiency, malabsorption syndromes, and the effects of drugs such as anticonvulsants, methotrexate, and chemotherapy)?
Regarding treatment:
- Is individual compliant with the treatment of B12 injections, if appropriate?
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Have appropriate drugs been eliminated as indicated?
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Have underlying malabsorption syndromes been addressed in the treatment plan?
Regarding prognosis:
- Does individual have any existing conditions that could affect recovery, such as pancreatic disease or autoimmune conditions?
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Have appropriate accommodations been made so individual can return safely to work? Has individual had any neurological complications? If so, has he or she been reassigned to sedentary work?
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Has individual been trained to watch for symptoms of other conditions that could develop (i.e., stomach polyps, cancer, thyroid disease, or renal failure)?
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Source: Medical Disability Advisor
| CitedConrad, Marcel E. "Pernicious Anemia." eMedicine. Eds. David Aboulafia, et al. 7 Jan. 2005. Medscape. 20 Oct. 2004 <http://emedicine.com/med/topic1799.htm>.Stone, Katie L. "Low Serum Vitamin B-12 Levels are Associated with Increased Hip Bone Loss in Older Women: a Prospective Study." Journal of Clinical Endocrinology and Metabolism 89 3 (2004): 1217-1221. MD Consult. Elsevier, Inc. 20 Oct. 2004 <http://home.mdconsult.com/das/journal/view/41764989-2/N/14528053?sid=280374957&source=MI>. Hart, Jacqueline A. "Pernicious anemia." MedlinePlus. National Library of Medicine. 20 Oct. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/000569.htm>. |
Source: Medical Disability Advisor
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