Pernicious anaemia

Question 1

Pernicious anaemia is a cause of (…?) deficiency anaemia

Answer 1

B12 deficiency anaemia

Question 2

Aside from pernicious anaemia, give another cause of B12 deficiency anaemia

Answer 2

Insufficient dietary intake

Question 3

Describe the pathophysiology of pernicious anaemia

Answer 3

Autoimmune condition - autoantibodies attack parietal cells and/or intrinsic factor, therefore vitamin B12 cannot be absorbed

Question 4

Which cells produce intrinsic factor?

Answer 4

Parietal cells in the stomach

Question 5

Where is vitamin B12 absorbed?

Answer 5

Terminal ileum (bound to intrinsic factor)

Question 6

What are the symptoms/signs of pernicious anaemia?

Answer 6

Vitamin B12 deficiency can cause neurological symptoms:

• Peripheral neuropathy
• Paraesthesia

Question 7

Which autoantibodies may be present in a patient with pernicious anaemia?

Answer 7

Intrinsic factor antibodies (first line investigation)

Question 8

Describe the management of pernicious anaemia

Answer 8

IM hydroxycobalamin

Question 9

If you have a patient with combined folate and vitamin B12 deficiency, which deficiency do you treat first? Why is this?

Answer 9

Treat B12 deficiency BEFORE treating folate deficiency (treating patients with folic acid when they have a B12 deficiency can lead to subacute combined degeneration of the cord)