ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Addisonian Pernicious Anemia And Other Congenital Causes Of Anemia

Updated on January 18, 2014

Pernicious Anemia Patient



This disorder is also known as just pernicious anemia or Biermer’s anemia.

Etiology: Pernicious anemia is common among the Caucasian population, but is very rare in Indian and African subjects. It is found more often in the older age groups and only rarely before 30 years of age. It may be familial and affects both sexes. Antibodies directed against the gastric parietal cells are present in the serum in 85- 90% of cases and antibodies against intrinsic factor are demonstrable in the serum as well as in the gastric juice in a smaller proportion of cases. Autoimmune mechanisms are probably responsible for their presence. The gastric mucosa undergoes atrophy resulting in the absence of intrinsic factor and gastric acid. Dietary vitamin B12 is not absorbed. Other disorders like myxedema, Addison’s disease, thyrotoxicosis, Hashimoto’s disease and vitiligo may occur along with pernicious anemia. Carcinoma of the stomach develops in 4% of cases when followed up for long periods.

Diarrhea: One Of The Symptoms Of Pernicious Anemia


Clinical Features And Manipulations

Clinical features

The onset is insidious. In addition to symptoms of anemia, special features include soreness of the tongue, paraesthesia of hands and feet, diarrhea and yellowish tinge of skin and mucous membranes. The tongue is atrophic. Spleen is palpable in 25% of cases. Psychiatric symptoms are common. Spinal cord lesions take the form of subacute combined degeneration in which varying combinations of posterior column and pyramidal tract dysfunction are encountered. If left untreated, the disease follows a prolonged course, ending fatally due to severe anemia or its complications.

Laboratory findings

Erythrocytes are macrocytic with marked anisopoikilocytosis. The bone marrow is megaloblastic. In a florid case, the hemoglobin isusually below 7 g/dl. Leucopenia and thrombocytopenia are common. Gastric analysis shows histamine fast achlorhydria and absence of intrinsic factor (achylia gastric). Serum vitamin B12 is below 80 pg/ml. Serum and red cell folate are normal. Serum Iron levels are elevated.

Defect of absorption of vitamin B12 and its correction by addition of intrinsic factor present in normal gastric juice can be demonstrated by Schilling’s test using radioactive vitamin B12. Parietal cell antibodies which are detectable in the serum are helpful in diagnosis.


In severe cases, where the hemoglobin is below 5g/dl, transfusion of packed erythrocytes may be required. Specific therapy is to give hydroxocobalamin 1000 ug intramuscularly every week till Hb level becomes normal. Reticulocyte response is noticed within 2 to 3 days of the first injection. Folic acid is contraindicated since it is known to precipitate the neurological complications, if administered alone.

Treatment Plan Of Pernicious Anemia



Subjects with pernicious anemia should receive lifelong supplementation of parenteral vitamin B12, 1000 ug every month.

Congenital megaloblastic anemias: Though in the vast majority of cases of pernicious anemia, the defect in intrinsic factor is an acquired one, it can be congenital in some rare cases.

Congenital intrinsic factor deficiency: In this condition, the gastric histology and secretions are normal except for the absence of intrinsic factor.

Congenital deficiency of transcobalamin II (TCII) also causes megaloblastic anemia. In this condition, the serum level of vitamin B12 is normal, but since it is bound to transcobalamin I, it is not available for hematopoiesis.

© 2014 Funom Theophilus Makama


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)