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| '''For patient information click [[Pernicious anemia (patient information)|here]]'''
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| {{Search infobox}} | | '''For patient information click [[Pernicious anemia (patient information)|here]]''' |
| {{CMG}} | | {{Pernicious anemia}} |
| | {{CMG}} {{AE}}{{Faizan}} |
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| | {{SK}} Biermer's anemia; Addison's anemia; Addison-Biermer anemia; pernicious anaemia. |
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| | ==[[Pernicious anemia overview|Overview]]== |
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| | ==[[Pernicious anemia historical perspective|Historical Perspective]]== |
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| ==Overview== | | ==[[Pernicious anemia classification|Classification]]== |
| '''Pernicious anemia''' (also known as ''Biermer's anaemia'' or ''Addison's anaemia'' or ''Addison-Biermer anaemia'') is a form of [[megaloblastic anaemia]] due to [[vitamin B12|vitamin B<sub>12</sub>]] deficiency dependent on impaired absorption of vitamin B<sub>12</sub> in the setting of [[atrophic gastritis]], and more specifically of loss of [[stomach|gastric]] [[parietal cell|parietal cells]]. While the term "pernicious anaemia" is sometimes also incorrectly used to indicate [[megaloblastic anaemia]] due to ''any'' cause of [[vitamin B12|vitamin B<sub>12</sub>]] deficiency, its proper usage refers to that caused by atrophic gastritis and parietal cell loss only.
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| ==Pathophysiology== | | ==[[Pernicious anemia pathophysiology|Pathophysiology]]== |
| Vitamin B<sub>12</sub> cannot be produced by the human body, and must therefore be obtained from diet. Normally, dietary vitamin B<sub>12</sub> can only be absorbed by the [[ileum]] when it is bound by the [[intrinsic factor]] produced by [[parietal cell|parietal cells]] of the [[stomach|gastric]] [[mucosa]]. In pernicious anaemia, this process is impaired because of loss of parietal cells, resulting in insufficient absorption of the vitamin, which over a prolonged period of time ultimately leads to vitamin B<sub>12</sub> deficiency and thus [[megaloblastic anaemia]].
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| ==Etiology== | | ==[[Pernicious anemia causes|Causes]]== |
| Most commonly, the cause for impaired binding of vitamin B<sub>12</sub> by intrinsic factor is [[autoimmune]] [[atrophic gastritis]], in which [[autoantibody|autoantibodies]] are directed against [[parietal cell|parietal cells]] (resulting in their loss) as well as against the [[intrinsic factor]] itself (rendering it unable to bind vitamin B<sub>12</sub>). Less frequently, loss of parietal cells may simply be part of a widespread atrophic gastritis of non-autoimmune origin, such as that frequently occurring in elderly people affected with long-standing chronic [[gastritis]] of any cause (including [[Helicobacter pylori]] infection). Note that forms of vitamin B<sub>12</sub> deficiency other than pernicious anaemia must be considered in the [[differential diagnosis]] of [[megaloblastic anaemia]].
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| ==Symptoms== | | ==[[Pernicious anemia differential diagnosis|Differentiating Pernicious anemia from other Diseases]]== |
| The presentation of pernicious anaemia resembles that of any other form of anaemia, but is often accompanied by the manifestations of vitamin B<sub>12</sub> deficiency (notably neurological abnormalities such as [[peripheral neuropathy]]), as well as by other manifestations of autoimmune atrophic gastritis.
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| ==Diagnosis== | | ==[[Pernicious anemia epidemiology and demographics|Epidemiology and Demographics]]== |
| A diagnosis of pernicious anaemia first requires demonstration of [[megaloblastic anaemia]] (through a [[full blood count]]) and of its direct cause, vitamin B{{ssub|12}} deficiency (by measuring B{{ssub|12}} levels in serum). A [[Schillings test]] can then be used to distinguish pernicious anemia from other causes of vitamin B{{ssub|12}} deficiency (notably [[malabsorption]]. A diagnosis of [[atrophic gastritis]] should be confirmed by [[gastroscopy]] with [[biopsy|biopsies]]. Approximately 90% of individuals with pernicious anemia have antibodies for parietal cells, however only 50% of individuals with these antibodies have pernicious anaemia.
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| ===Pathology=== | | ==[[Pernicious anemia risk factors|Risk Factors]]== |
| [[Image:B12 anemia (pernicious), megaloblastic anemia, hypersegs.jpg|thumb|left|300px|B12 anemia (pernicious), megaloblastic anemia, hypersegs<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>]] | |
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| ==Treatment== | | ==[[Pernicious anemia screening|Screening]]== |
| Being a manifestation of vitamin B{{ssub|12}} deficiency, pernicious anaemia is treated by administering vitamin B{{ssub|12}} supplements. Note that if oral tablets are chosen for this purposes, much higher doses are given than normally required in order to overcome the impaired absorption that characterises pernicious anaemia. If oral tablets are not sufficient, vitamin B{{ssub|12}} can also be administered via [[Injection_%28medicine%29|injection]]. Often the patient can learn to do this at home.
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| ===History=== | | ==[[Pernicious anemia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The treatment for pernicious anemia was first devised by [[George Whipple]] 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 Richards Minot|George Minot]] and [[William Murphy]] then set about to chemically isolate the curative substance and ultimately were able to isolate the vitamin B{{ssub|12}} from the liver. For this, all three shared the 1934 [[Nobel Prize in Physiology or Medicine|Nobel Prize in Medicine]]. As a result, pernicious anemia is now treated with either vitamin B{{ssub|12}} injections, or large oral doses of vitamin B{{ssub|12}}, typically between 2 and 4 mg daily.
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| ==Famous sufferers== | | ==Diagnosis== |
| *Inez Milholland, American Suffragette.
| | [[Pernicious anemia history and symptoms|History and Symptoms]] | [[Pernicious anemia physical examination|Physical Examination]] | [[Pernicious anemia laboratory findings|Laboratory Findings]] | [[Pernicious anemia other diagnostic studies|Other Diagnostic Studies]] |
| *Alexander Graham Bell, Scottish scientist and inventor.
| | ==Treatment== |
| *Annie Oakley.
| | [[Pernicious anemia medical therapy|Medical Therapy]] | [[Pernicious anemia surgery|Surgery]] | [[Pernicious anemia prevention|Prevention]] | [[Pernicious anemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pernicious anemia future or investigational therapies|Future or Investigational Therapies]] |
| *Norman Warne, Editor/Publisher & fiance of Beatrix Potter.
| | ==Case Studies== |
| *Yoon Eun Hye, A South Korean actress
| | [[Pernicious anemia case study one|Case #1]] |
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| {{Hematology}} | | {{Hematology}} |
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