Optimal management of pernicious anemia

Figures & data

Table 1 Elements of the hematological manifestations of vitamin B12 deficiency

CBC: genuine aregenerative, normochromic, and macrocytic anemia; generally associated with moderate leukopenia and thrombopenia.

Blood smear: large red blood cells, anisocytosis, Howell–Jolly bodies, and globular-shape cells in the form of ovalocytes; large-size granulocytes with hypersegmentation of the nuclei (shift to the right in Arneth’s formula).

Biology: elevated serum levels of LDH and free bilirubin and decreased levels of haptoglobin (hemolysis by ineffective intramedullary erythropoiesis).

Spinal smear: rich and bluish spinal fluid due to cytoplasmic hyperbasophilia; increased medullary erythroblastosis with megaloblastic erythroblasts. All stages of erythroid maturation are represented but the asynchrony of nucleocytoplasmic maturation is marked by immature nuclei and an already acidophilic cytoplasm.

Abbreviations: CBC, complete blood count; LDH, lactate dehydrogenase.

Table 2 Main clinical manifestations of vitamin B12 deficiency

Neuropsychiatric manifestations	Digestive manifestations	Other manifestations
Frequent	Frequent	Vaginal mucosa atrophy
Combined sclerosis of the spinal cord	Hunter’s glossitis	Urogenital infections (especially mycoses)
Polyneuritis	Hemolytic icterus	Rebellious or recurrent cutaneous–mucosal ulcers
Ataxias	Others	Thrombosis (venous thromboembolism and ischemic heart disease)
Babinski	Abdominal pain	Subfertility and recurrent spontaneous abortions/male infertility
Rare	GI transit disorders
Cerebellar syndrome
Cranial nerve impairment
Sphincter dysfunctions
Others
Memory impairments
Dementia
Atherosclerosis
Parkinsonism
Depression

Abbreviation: GI, gastrointestinal.

Figure 1 Vitamin B12 metabolism, etiological implications, and elements of clinical course.

Abbreviations: IF, intrinsic factor; HCl, hydrogen chloride.