• Pernicious Anemia

    (Juvenile Pernicious Anemia; Congenital Pernicious Anemia)


    Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low the body does not get enough oxygen.
    Pernicious anemia is associated with problems absorbing vitamin B12. This vitamin is needed to make healthy RBCs. Over time the low vitamin B12 levels will reduce the number of new RBCs. The sooner pernicious anemia is treated, the better the outcome.
    Red Blood Cells
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    There are many possible causes of pernicious anemia. These include:
    • Inflammation of the stomach—atrophic gastritis
    • Immune system reaction to:
      • Intrinsic factor—a protein necessary for vitamin B12 absorption
      • Cells that produce both intrinsic factor and hydrochloric acid in the stomach
    • Removal of all or part of the stomach
    • Genetic defect

    Risk Factors

    Pernicious anemia is more common in people over 50 years old, and in those of northern European or Scandinavian descent. Factors that may increase your chance of pernicious anemia include:
    Autoimmune disorders, such as:


    Pernicious anemia symptoms can vary from person to person. Symptoms may change or worsen over time.
    Pernicious anemia may cause:
    • Sensation of pins and needles in feet or hands
    • Alternating constipation and diarrhea
    • Stinging sensation on the tongue, or a smooth red tongue
    • Substantial weight loss
    • Inability to distinguish the colors yellow and blue
    • Fatigue
    • Paleness
    • Loss of hunger
    • Altered sense of taste
    • Confusion
    • Depression
    • Impaired sense of balance, especially in the dark
    • Ringing in the ears—tinnitus
    • Cracked lips
    • Fever
    • Inability to sense vibrations in feet or legs
    • Lightheadedness when changing to standing position
    • Rapid heart rate


    You will be asked about your symptoms and medical history. A physical exam will be done.
    Blood tests are used to evaluate specific components to determine if there is a deficiency in proteins, vitamins, or building blocks.
    Other tests may include:
    • Bone marrow biopsy
    • Gastric cell biopsy
    • Shilling test (rare)—to evaluate the amount of stored vitamin B12


    Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Vitamin B12 Injections

    The treatment consists of injections of vitamin B12 into a muscle. These injections are necessary because the intestines cannot absorb enough vitamin B12 without an adequate supply of intrinsic factor from the stomach.

    Oral Vitamin B12 Supplement

    If you are an older adult, your doctor may advise you to take oral B12 supplements alone or in addition to injections of vitamin B12.

    Intranasal Vitamin B12

    Your doctor may give you a supplement of vitamin B12 that is sprayed into the nose.

    Oral Iron Therapy

    This treatment is recommended when an iron deficiency exists. In this case, the doctor will tell you to take iron supplements before treating with vitamin B12.


    There are no current guidelines to prevent pernicious anemia.


    Family Doctor—American Academy of Family Physicians https://familydoctor.org

    National Institutes of Health Office of Dietary Supplements https://ods.od.nih.gov


    Health Canada https://www.canada.ca

    The College of Family Physicians of Canada http://www.cfpc.ca


    Explore pernicious anemia. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia. Accessed April 1, 2011. Accessed September 29, 2017.

    Pernicious anemia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116294/Pernicious-anemia. Updated May 17, 2017. Accessed September 29, 2017.

    Vitamin B12. National Institutes of Health Office of Dietary Supplements website. Available at: https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. Updated February 11, 2016. Accessed September 29, 2017.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
    • Review Date: 09/2017
    • Update Date: 09/30/2013
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