clinical features

Last edited 04/2020

Clinical features are those of vitamin B12 deficiency. However in pernicious anaemia there is an insidious onset and so there may be a profound degree of anaemia at the time of diagnosis.

Possible clinical features of pernicious anaemia include (1,2,3)

• general features include:
• tiredness/lethargy
• dry skin
• brittle nails
• glossitis - beefy red tongue
• alopecia or greying
(premature greying of the hair)
• low grade pyrexia
• weight loss
• reduced appetite
• lemon yellow colour:
• jaundice, due to haemolysis
• pallor, due to anaemia
  
  
• neurological features include:
  • dementia/memory loss/poor concentration
  • peripheral neuropathy, subacute combined degeneration of the cord - paraesthesia, numbness, difficulty in walking, weakness
  
  
  
• cardiorespiratory features
include:
• palpitations, shortness of breath
  
  
• gastrointestinal features include:
• anorexia, weight loss
• diarrhoea, altered bowel habit, malabsorption
• taste disturbance
  
  
• psychological/psychiatric features include:
• depression
• irritability
• emotional lability
  
  
• ophthalmalogical features include:
• retrobulbar neuritis - poor vision
• optic atrophy - blindness
  

Notes:

• incidence of low-grade fever in nutritional megaloblastic anemia varies from 28% to 60% (3)
- however attributing a low grade fever to this scenario requires exclusion of infective and inflammatory causes of fever

Reference:

• Mohamed M et al. Pernicious anaemia. BMJ 2020;369:m1319.
• Pulse 2004; 64(35):88.
• Tahlan A et al. Spectrum and analysis of bone marrow findings in anemic cases. Indian J Med Sci. 2008;62:336-9