Pernicious Anemia - Signs and Symptoms

Signs and Symptoms

Pernicious Anemia (PA), untreated, is fatal. PA presents insidiously, and many of the signs and symptoms are due to anemia itself, where anemia is present. However, in 20% of cases of cobalamin deficiency, anemia is not observed. While it may consist of the triad of paraesthesias, sore tongue and weakness, this is not the chief symptom complex. Common symptoms include fatigue, depression, forgetfulness, difficulty concentrating, low-grade fevers, nausea and gastrointestinal symptoms (heartburn), weight loss. Because PA may affect the spinal cord, symptoms may also include impaired urination, loss of sensation in the feet, unsteady gait, weakness, and clumsiness. Anemia may cause tachycardia (rapid heartbeat) and cardiac murmurs, along with a waxy pallor. In severe cases, the anemia may cause evidence of congestive heart failure.

Long-term complications may include gastric cancer and carcinoids.

A patient with well-treated pernicious anemia (PA) can live a healthy life, although exhausation, memory loss and other symptoms may persist depending on the stage in which the individual was diagnosed. Failure to treat can lead to severe consequences for those with severe PA. Giving rise to the its name, "pernicious," meaning fatal, patients may experience symptoms such as severe fatigue, depression, irritability, neurological damage, heart and organ failure, and even death. Having PA is not a death sentence, however, so long as it is properly maintained. Patients should regularly see their doctors for checkups and keep up with cyanocobalamin injections.

Many signs and symptoms are attributed to PA:

• Fatigue, low blood pressure, rapid heart rate, high blood pressure, pallor, depression, muscle weakness, and shortness of breath (known as 'the sighs')
• 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 including irritability and depression
• Dehydrated/cracked and pale lips and dark circles around the eyes (look of exhaustion)

A complication of severe chronic PA is subacute combined degeneration of spinal cord, which leads to distal sensory loss (posterior column), absent ankle reflex, increased knee reflex response, and extensor plantar response.