Pernicious Anemia

Pernicious anemia is the megaloblastic anemia due specifically to vitamin B12 deficiency, in which there is also spinal cord degeneration and peripheral neuropathy. It is a disease of later life. Only about 10% of patients are under age 40; by the age of 60, about 1% of the population is affected, rising to 2% to 5% of people over age 65, as a result of atrophic gastritis and thus impaired absorption of vitamin B12 (Section 10.7.1).

Early studies suggested that folate supplements exacerbate or hasten the development of the neurological damage in vitamin B12 deficiency. There is little evidence that this is so, but high intakes of folate will prevent the development of megaloblastic anemia in vitamin B12 deficiency. In up to one-third of patients, the neurological signs appear without development of megaloblastic anemia (Dickinson, 1995).

Failure of intrinsic factor secretion is commonly a result of autoimmune disease; 90% of patients with pernicious anemia have complement-fixing antibodies in the cytosol of the gastric parietal cells. Similar autoantibodies are found in 30% of the relatives of pernicious anemia patients, suggesting that there is a genetic basis for the condition.

About 70% of patients also have antiintrinsic factor antibodies in plasma, saliva, and gastric juice. These canbe either blocking antibodies, which prevent the binding of vitamin B12 to intrinsic factor, or precipitating antibodies, which precipitate both free intrinsic factor and intrinsic factor-vitamin B12 complex. Some patients have both types of antiintrinsic factor antibody. Although the oral administration of partially purified preparations of intrinsic factor will restore the absorption of vitamin B12 in many patients withpernicious anemia, this can eventually result in the production of antiintrinsic factor antibodies, so parenteral administration of vitamin B12 is the preferred means of treatment.

For patients who secrete antiintrinsic factor antibodies in the saliva or gastric juice, oral intrinsic factor will be of no benefit.

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