Pernicious Anaemia

For anyone who read my earlier post 5 Facts you will know about my suffering of medical student syndrome (MSS). Anyway, I was revising pernicious anaemia, and realised that most of the symptoms actually fit me right now. Of course I have many conditions that can all be boiled down to MSS, if I went to the GP with all the things I thought were wrong with me I’d have probably been blacklisted by now. The downside is that if I ever am actually ill, I’ll probably get really really sick before I can convince my incredibly cynical brain that it’s actually a problem and not my imagination. So if I suddenly disappear… yeah.

The only one of my many “illnesses” that I’ve been to the GP with is my hypermobility. And that was purely because I was trying to wangle a physiotherapy referral that he definately wasn’t going to give me until I threw in the little nugget of information that the hurting knee actually bends backwards. As do all my other joints.

Anyway, these are the symptoms of pernicious anaemia. This is partly for my benefit, and partly for everyones, as from what I can tell it’s incredibly underdiagnosed in this country. And yes, this is stolen from wiki.

  • Fatigue, low blood pressure, rapid heart rate, high blood pressure, pallor, depression, muscle weakness, and shortness of breath
  • Difficulty in proprioception
  • Mild cognitive impairment, including difficulty concentrating and sluggish responses, colloquially referred to as brain fog
  • Neuropathic pain
  • Frequent diarrhea
  • Paresthesias, such as pins and needles sensations or numbness in fingers or toes, due to B12 deficiency affecting nerve function
  • Jaundice due to impaired formation of blood cells
  • Glossitis (swollen red tongue) due to B12 deficiency
  • May present with hyperthyroidism or hypothyroidism
  • Personality or memory changes

All I thought when I read this was “HAH, hyperthyroidism is in there! My ‘diseases’ actually link up!” Which says a lot.

Anyhoo, it’s hard to diagnose, but symptoms + low levels of vitamin B12 or antibodies to intrinsic factor (more on that in a bit) are sort of indicative. They used to do a test called the Schilling test, where they essentially treated you for Pernicious Anaemia, then withdrew treatment to see if you got worse again. But they don’t do that any more.

Vitamin B12 requires something called intrinsic factor to be absorbed. They bind together and make a complex, and then this can pass through the cells of the small intestine into the bloodstream, where the B12 detaches and goes on it’s way to make nerves and stuff. Intrinsic factor is secreted by cells in the stomach, and after helping vitamin B12 get absorbed, is itself reabsorbed in the very last bit of the small intestine (which is called the terminal ileum). Pernicious anaemia is caused by a lack of intrinsic factor. This is usually due to an autoimmune condition, where the immune system goes a bit crazy and starts attacking the cells in the stomach that secrete intrinsic factor. No intrinsic factor means that vitamin B12 can’t be absorbed, which causes all the symptoms of pernicious anaemia.

You can’t really cure this, once the cells have been vamooshed that’s it, they’re gone forever. The treatment is actually pretty simple, you just give them vitamin B12 supplements to top them up. This can be done wither by injection, or orally.

But wait! I hear you cry. If their problem is that they can’t absorb vitamin B12, how does giving them oral vitamin B12 work? Surely they just won’t absorb that either? Well, generally the patient will be able to absorb at least SOME of it, and by giving supplements, there is more there for their limited supplies of intrinsic factor to work on. The people who have it really badly tend to end up on the injections every three months so it’s all good.

And THAT, my good friends, is everything you will EVER need to know about a disease that I may or may not (more likely not) have.

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Hi. I am a 23 year old final year medic in the UK.

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