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Nov 8, 2017 in Opinion

Pernicious Anaemia

Pernicious Anaemia Definition and History

From the moment of its discovery until nowadays, pernicious anaemia has become and remains one of the most exciting topics in medicine. It was first described in 1855 by Dr. Thomas Addison whence it acquired the name Addison’s disease. Until the 1920s pernicious anaemia remained lethal. Recognized as an incurable affliction, its treatment consisted primarily of blood transfusions which served the sole purpose of postponing inevitable death (Eppinger 783). However in 1926, a group of three physiologists discovered the liver therapy in order to celebrate one of the century’s great scientific breakthroughs and to share the 1934 Nobel Prize for medicine. Despite the magnitude of their success for the time, George Whipple, William Murphy and George Manot only set the initial point for a long journey towards the exploration of the disease. Thanks to the efforts of such men present day science has expanded substantially from the background of past experience in order to provide a much more detailed picture of the true nature of pernicious anaemia, its signs, causes and symptoms. Once the problem has been clarified through an accurate diagnosis, a possible treatment and monitoring can take place.

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Pernicious anaemia refers to the chronic condition of insufficient red blood cells and subsequently to the blood’s inability to carry enough oxygen throughout the body. A characteristic of pernicious anaemia is the presence of enormously large (megaloblastic), immature erythrocytes. Although they are normochromic, containing haemoglobin within the standard range, they are insufficient in number (Hawley 52). Two reasons account for a drop in the number of red blood cells, either a decline in their production or an increase in their loss. The word ‘pernicious’ means harmful suggesting a usually subtle, long term deleterious effect on the organism while ‘anaemia’ is a general term linked with the shortage of erythrocytes in the body. The name ‘pernicious anaemia’ denotes a specific case of anaemia, when the body can’t receive enough vitamin12 from the latter’s absorption in the gastro-intestinal tract (Hawley 52).

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Pernicious anaemia develops slowly and the first symptoms do not appear until the haemoglobin levels have fallen drastically (below 8g/dL). It is caused by the malabsorption of vitamin B12 hampering the process of erythropoiesis which defines the formation of red blood cells (Hawley 52). Inside the stomach, a protein called intrinsic factor binds to vitamin B12 so that the newly formed complex passes the intestinal wall and crosses into the blood stream. In case of pernicious anaemia, this complex cannot form at all because the cells in the stomach responsible for the manufacture of intrinsic factor are damaged and hence unable to produce it. Consequently, vitamin B12 is no longer absorbed leading to deficiency and anaemia. Most frequently this is the result of gastric atrophy. The latter is caused by either innate autoimmune disorder leading to the production of parietal cell antibodies or the continuous exercise of harmful habits such as smoking or excessive drinking.

It is a common mistake to associate symptoms of pernicious anaemia with the shortage of red blood cells by itself. They should be rather regarded as the latter’s manifestation in disorders of the bone marrow, gastro-intestinal tract and the central nervous system. The signs of pernicious anaemia include pallor, weakness, breath shortness, fatigability. Indigestion, lack of appetite and general stomach discomfort are other signs found in individuals suffering from pernicious anaemia. They are consequences of the absence of hydrochloric acid. Moreover vitamin B12 is crucial for healthy nerves and hence the involvement of the central nervous system adds features such as head tingling, numbness, walking difficulties and occasionally, a loss of sphincter control. In rare instances, anaemia is related to psychosis. If left untreated, pernicious anaemia could potentially cause severe neurological disorders and death. An interesting symptom of anaemia is the curious desire to chew non-food items such as ice, starch, paper or clay. What triggers this kind of craving is unknown but if it appears, it is a sure sign of alert (Eppinger 783).

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