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Pernicious Anemia: Symptoms, Causes
and Treatment

Pernicious anemia (also known as Biermer's anemia, Addison's anemia, or Addison-Biermer anemia) is one of many types of the larger family of megaloblastic anemias. It is caused by loss of gastric parietal cells, and subsequent inability to absorb vitamin B12.


Weakness, slight yellowing of the skin, tingling of the extremities, and gastrointestinal disturbances causing a sore tongue. There can be partial loss of coordination of the finger, feet, and legs. Some nerve deterioration may occur. Diarrhea and loss of appetite may also be present.

The pale hand of a woman with severe anemia (right) in comparison to the normal hand of her husband (left).
Attribution: James Heilman, MD.


Pernicious anemia is caused by a deficiency of vitamin B12. This is a severe form of anemia in which the bone marrow fails to produce mature red blood cells. Other causes include eating junk food, malabsorption problems, Crohn’s disease, gastric surgery, and drugs which have destroyed the ability of the large bowel to produce B12.

The stomach has to be able to produce, what is known as, “intrinsic factor” in order for vitamin B12 to be absorbed by the intestines. Pernicious anemia rarely occurs under the age of 30; but it becomes more common afterward.

In some instances, B12 deficiency can be diagnosed by a physician who uses a Schilling test, a special blood test which evaluates B12 absorption.


The treatment of pernicious anemia varies from country to country and from area to area. There is no permanent cure for pernicious anemia, although repletion of vitamin B12 should be expected to result in a cessation of anemia-related symptoms, a halt in neurological deterioration, and (in cases where neurological problems are not advanced) neurological recovery and a complete and permanent remission of all symptoms, so long as B12 is supplemented. Repletion of B12 can be accomplished in a variety of ways.

The most accessible and inexpensive method of repletion is through dietary supplementation, in the form of oral or sublingual B12 tablets. B12 supplements are widely available at supermarkets, health food stores, and drug stores, though quality and cost may vary. In some countries, the cobalamin preparation may be available only via prescription. Doctors can prescribe cobalamin tablets that contain doses higher than what is commercially available.

Without treatment, pernicious anemia may be fatal.

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