PERNICIOUS ANAEMIA

Introduction
It is a disorder caused by the deficiency of vitamin B12 and hence the body produces insufficient blood cells.

Risk Factors
If there is a family history of the condition.
Autoimmune disorders like Addison’s disease, Grave’s disease, Hypopituitarism, Secondary amenorrhea, type 1 diabetes may pose a risk in developing vitamin B12 deficiency.
In certain Races such as north European, Scandinavian there is predilection towards Vitamin B12 deficiency.

Causes of Pernicious Anaemia
We need Vitamin B12 in order to generate red blood cells. The vitamin is obtained from diet such as meat, chicken, egg, shellfish and diary products.
The anaemia results from the inability to transport vitamin B12 across the intestinal mucosa because of the absence of a gastric substance called as the intrinsic factor. This intrinsic factor is normally complexes with Vitamin B12 making the vitamin available to mucosal cells for absorption. There is an auto immune response where in the body acts against the intrinsic factor producing cells. As a result of this the stomach does not make enough intrinsic factor and the intestine does not absorb Vitamin B12.

Symptoms of Pernicious Anaemia

1. It includes general fatigue and weakness, shortness of breath, constipation or diarrhoea.
   
2. Presence of neurological symptoms such as headache, confusion, depression, loss of balance and numbness.
   
3. Special oral complaints centre on the tongue. Pain and burning are the typical symptoms. The tongue appears redder due to the shrinkage of the papillae. The resultant smooth, red appearance of the tongue is been referred to as Hunter’s glossitis or Moeller’s glossitis.
   

Complications of Pernicious Anaemia

1. Dementia
   
2. Depression
   
3. Increased risk of stomach cancer
   
4. Nerve problems that cause pain, numbness or tingling.
   
5. Problems with balance and coordination
   
6. Stomach polyps
   

Treatment of Pernicious Anaemia

1. Usually injections of Vitamin B12 are administered monthly. It corrects the anaemia and also the neurological symptoms if taken early. In cases having more severe deficiency, the injections are administered more frequently.
   
2. Elderly patients are given oral supplements and monthly injections.
   
3. Drops of vitamin B12 preparation may be given via the nose.
   
4. A well balanced diet rich in folic acid, Vitamin C is given.
   

References

1. Anthony AC megaloblastic anaemia, Haematology: Basic principles and practice.5the ed. Philadelphia.
   
2. Oral pathology by Regezi. Sciubba.Jordan.
   
3. http://www.nlm.nih.gov/medlineplus/ency/article/000569.htm
   

Tests of Pernicious Anaemia
It usually begins with a thorough history and physical examination. Other tests that help in the diagnosis of pernicious anaemia are 

1. Complete blood count to know the type of anaemia and know whether anaemia is present.
   
2. Examination of blood smears to observe the blood cells and obtain Complete blood count.
   
3. Tests to measure the level of methylmalonic acid which may be sensitive indicators of vitamin B12 deficiency.
   
4. In some cases of bone marrow disorders, bone marrow aspiration may be done.
   
5. Other tests include Schilling test, Serum Vitamin B12 level, Reticulocyte count.