Paper
Pernicious Anaemia
Published Jul 1, 1957 · M. Israëls
International Journal of Clinical Practice
76
Citations
5
Influential Citations
Abstract
WH EN A PATIENT over 45 years old develops a lemon-yellow pallor, gets a smooth sore tongue, complains of dyspnoea and palpitation on exertion and of pins-andneedles and numbness in the hands and feet, the possible diagnosis of pernicious anaemia at once comes to mind. Confirmatory clinical points are a history of slow onset, of flatulent indigestion, of loss of appetite without loss of weight, or oedema of the ankles without albuminuria, and the fact that the patient often walks into the clinic with a haemoglobin level of 30 per cent and resents the suggestion that she really ought to be in bed. The blood count typically shows red cells much more reduced than the haemoglobin level so that the colour index is I plus. The red cells on the blood smear show great variation in size and shape and there are always some large well-filled cells to be seen among them. The polymorphonuclears show characteristic nuclei with more lobes than normal and leucopenia is the rule. Two other laboratory tests arc now considered indispensable for confirmation of the diagnosis: the fractional gastric analysis should show a histamine-fast achlorhydria, and the sternal marrow smear should show typical megaloblastic erythroblasrs and giant metamye!ocytcs. But many patients present in different ways, some of which arc illustrated by the case records which follow. The commonest deceiver is a preceding illness that masks the slow onset of the pernicious anaemia, and here must be specially noted the patient with iron-deficiency anaemia who is at first successfully treated, but relapses perhaps a year or two later and then fails to respond to iron treatment. Unless the patient's progress is being controlled by proper full blood counts, the change in diagnosis will be masked for some time.
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