PERNICIOUS-ANEMIA REVISITED

Objective: We discuss the pathophysiologic mechanisms, clinical featur es, diagnosis, and treatment of pernicious anemia (PA). Design: A revi ew of the clinical applications of the diagnostic and therapeutic prog ress of PA is presented. Material and Methods: A patient with PA may h ave a wide range of initial complaints that affect various organ syste ms or may be entirely asymptomatic. Hematologic variables may be norma l in patients with cobalamin (Cbl) deficiency. Because of the difficul ties in diagnosing Cbl deficiency, alternatives to measuring Cbl have been sought. Determining the urinary methylmalonic acid level is a les s invasive, more practical, and, possibly, more sensitive method. The Schilling test is performed for assessment of the absorption of orally ingested radio-labeled crystalline cyano-Cbl; results should be inter preted cautiously. Results: Vitamin B-12 therapy should be lifelong. I t is customarily administered intramuscularly. Other routes of adminis tration have been studied. Conclusion: PA is one of the most treatable hematologic disorders.