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Pernicious anemia refers to a type of autoimmune anemia. Antibodies are directed against intrinsic factor or parietal cells which produce intrinsic factor. Intrinsic factor is required for vitamin B absorption, so impaired absorption of vitamin B can result.
The term pernicious anemia is sometimes used more loosely to include non-autoimmune causes of vitamin B deficiency.
Diagnosis
Blood testing typically shows a macrocytic anemia, and low levels of serum vitamin B. A Schilling test can then be used to distinguish between pernicious anemia, vitamin B malabsorption, and vitamin B deficiency. Approximately 90% of individuals with pernicious anemia have antibodies for parietal cells, however only 50% of individuals with these antibodies have the disease.
History
The treatment for pernicious anemia was first devised by William Murphy who bled dogs to make them anemic and then fed them various substances to see what (if anything) would make them healthy again. He discovered that ingesting large amounts of liver seemed to cure the disease. George Minot and George Whipple then set about to chemically isolate the curative substance and ultimately were able to isolate the vitamin B from the liver. For this, all three shared the 1934 Nobel Prize in Medicine. As a result, pernicious anemia is now treated with either vitamin B injections (hydroxocobalamin or cyanocobalamin), or large oral doses of vitamin B, typically between 2 and 4 mg daily.
Maurice Beddow Bayly, an anti-vaccinationist and anti-vivisectionist, campaigned against the use of liver therapy, having failed to recognise the nature of the disease (despite reciting the necessary information) .
Symptoms
Pernicious anemia may cause inflammation of the tongue (glossitis). It is also associated with premature greying, blue eyes, vitiligo, and blood group A.
Treatment
Treatment is with vitamin B (hydroxycobalamin or cyanocobalamin) injected intramuscularly. Body stores (in the liver) are refilled with half a dozen injections in the first couple of weeks and then maintenance with monthly to quarterly injections throughout the life of the patient.
B has traditionally been given parenterally to ensure absorption. However, oral replacement is now an accepted route, as it has become increasingly appreciated that sufficient quantities of B are absorbed when large doses are given. This absorbance does not rely on the presence of intrinsic factor or an intact ileum. Generally 10 to 20 mg daily is required *. By contrast, the typical Western diet contains 5–7 µg of B (Food and Drug Administration (FDA) Daily Value ).
See also
External links
- The Pernicious Anaemia Society, a UK-based charitable organisation which operates a forum where you can discuss Pernicious Anaemia with other sufferers around the world.
Perniziöse Anämie | Anemia perniciosa | אנמיה ממארת | Pernicieuze anemie | Niedokrwistość Addisona-Biermera | Pernisyöz anemi
"Pernicious anemia"