HISTORY. Because large stores of vitamin B12 are present in the body, signs and symptoms of pernicious anemia may not appear for some time. Ask the patient if he or she has experienced repeated infections. Elicit a history of severe fatigue, weakness, anorexia, nausea, vomiting, flatulence, diarrhea, or constipation. Ask the patient if he or she has experienced a sore tongue or heart palpitations or recent difficulties in breathing after exertion.
Central nervous system findings are a hallmark of this anemia. Establish a history of sensory organ disturbance; ask the patient if he or she has experienced blurred or altered vision, altered taste, or altered hearing. Ask the patient if he or she has experienced numbness, tingling, lack of coordination, or lack of position sense. Ask male patients about recent experiences with impotence. Elicit any history of lightheadedness, memory lapses, faulty judgment, irritability, or paranoia.
Elicit a complete history of medical conditions, especially autoimmune-related disorders, such as thyroiditis, myxedema, and Graves' disease. Ask the patient if she or he has undergone a gastric resection or if any members of her or his family have had pernicious anemia.
PHYSICAL EXAM. The patient may appear listless. Note any premature graying or whitening of the hair. The patient may have waxy, pale to light lemon-yellow skin and jaundiced sclera. Inspect the patient's mouth and check for pale lips and gums and a beefy, red, smooth tongue as a result of papillary atrophy. Note any incidence of leg edema. Weight loss may be apparent.
Percussion or palpation of the abdomen may reveal an enlarged spleen and liver. You may note tachycardia and a rapid pulse rate. Auscultation of the heart may reveal a systolic murmur. Spinal degeneration may occur, and positive Romberg's and Babinski's signs may be a clinical finding.
PSYCHOSOCIAL. Pernicious anemia produces a variety of distressing signs and symptoms, such as changes in the function of the sensory organs, dietary habits, excretory function, and sexual performance. Appearance changes may disturb the patient as well. Neurological complications may cause paranoia, disorientation, or delirium.
|Test||Normal Result||Abnormality with Condition||Explanation|
|RBC count||4.05.5 million/µL||Macrocytic anemia; decreased RBC: < 4.0 million/µL||Development of abnormally large red blood cells because of vitamin deficiency|
|Vitamin B12 level (cobalamin level)||2001,100 pg/mL||Decreased||Deficit in absorption or intake; cobalamin is the family of chemicals that includes vitamin B12|
|Schilling test||> 10% absorption of administered dose of B12||< 10% absorption of administered dose of B12||Pernicious anemia leads to decreased absorption or intake|
|Serum antibodies to intrinsic factor||Negative||Positive||Type I antibodies occur in 70% of patients with pernicious anemia; type II antibodies occur in 40% of patients with pernicious antibodies|
Complete blood count, bilirubin, lactic dehydrogenase, bone marrow biopsy.
Pernicious Anemia has been found in Diseases and Disorders
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