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Pernicious anaemia

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

   CAPTION: Pernicious anaemia
   Classifications and external resources

     ICD- 10   D 51.0
     ICD- 9    281.0
   DiseasesDB  9870
   MedlinePlus 000569
    eMedicine  med/1799

   Pernicious anaemia refers to a type of autoimmune anaemia. Antibodies
   are directed against intrinsic factor or parietal cells which produce
   intrinsic factor. Intrinsic factor is required for vitamin B[12]
   absorption, so impaired absorption of vitamin B[12] can result. An
   anaemia is a deficiency of the blood cells, but in addition to blood
   cells, many other cells in the body need vitamin B[12], including nerve
   cells.

   The term pernicious anaemia is sometimes used more loosely to include
   non-autoimmune causes of vitamin B[12] deficiency.

Diagnosis

   Blood testing typically shows a macrocytic, normochromic anaemia, and
   low levels of serum vitamin B[12]. A Schilling test can then be used to
   distinguish between pernicious anaemia, vitamin B[12] malabsorption,
   and vitamin B[12] deficiency. Approximately 90% of individuals with
   pernicious anaemia have antibodies for parietal cells, however only 50%
   of individuals with these antibodies have the disease.

   Pernicious anaemia is more common among women (1.6 : 1) with a peak
   occurrence at the age of sixty. It has a hereditary component, and it
   is notably more common in persons of Northern European ancestry.

Symptoms

   Symptoms may include weakness, an abnormally rapid heartbeat (
   tachycardia), shortness of breath, chest pains, an upset stomach
   including diarrhea, difficulty walking, numbness and tingling in the
   extemities, lack of color (pallor) in the lips, gum, and tongue, and/or
   depression. Pernicious anaemia may cause inflammation of the tongue (
   glossitis). It is also associated with premature greying, blue eyes,
   vitiligo, and blood group A.

   It is also associated with unpredictable periods of fatigue and an
   inability to concentrate. Irreversible Central Nervous System (CNS)
   damage may have occurred prior to treatment. Scissors gait can appear
   as a late sign of unchecked anaemia.

   Some sufferers also report mouth ulcers, joint pain and tinnitus as
   associated with the onset of pernicious anaemia. see intrisnic factor

Treatment

   Treatment is with vitamin B[12] (hydroxycobalamin or cyanocobalamin)
   injected intramuscularly. Body stores (in the liver) are refilled with
   half a dozen injections in the first couple of weeks and then
   maintenance with monthly to quarterly injections throughout the life of
   the patient.

   B[12] has traditionally been given parenterally to ensure absorption.
   However, oral replacement is now an accepted route, as it has become
   increasingly appreciated that sufficient quantities of B[12] are
   absorbed when large doses are given. This absorption does not rely on
   the presence of intrinsic factor or an intact ileum. Generally 1 to 2
   mg daily is required as a large dose . By contrast, the typical Western
   diet contains 5–7 µg of B[12] ( Food and Drug Administration (FDA)
   Daily Value ).

History

   The treatment for pernicious anaemia was first devised by George
   Whipple who bled dogs to make them anaemia 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 Minot and William Murphy then set about to chemically
   isolate the curative substance and ultimately were able to isolate the
   vitamin B[12] from the liver. For this, all three shared the 1934 Nobel
   Prize in Medicine. As a result, pernicious anaemia is now treated with
   either vitamin B[12] injections (hydroxocobalamin or cyanocobalamin),
   or large oral doses of vitamin B[12], typically between 2 and 4 mg
   daily.

   Maurice Beddow Bayly, an anti-vaccinationist and anti-vivisectionist,
   campaigned against the use of liver therapy, having failed to recognise
   the nature of the disease (despite reciting the necessary information).

Synonyms

     * Addison's anaemia
     * Addison-Biermer Anaemia
     * Addisonian Pernicious Anaemia
     * Primary Anaemia

   Retrieved from " http://en.wikipedia.org/wiki/Pernicious_anemia"
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