Abstract
Background
Vitamin B12, or cobalamin, is a nutrient that is vital for metabolic function. Absorption
of ingested B12 is dependent on intrinsic factor, which is secreted by parietal cells
within the stomach. Pernicious anemia is caused by an intrinsic factor deficiency
or autoantibodies against intrinsic factor. The presence of parietal cell antibodies
can destroy parietal cells, which can also lead to a deficiency in intrinsic factor.
Both lead to megaloblastic anemia caused by vitamin B12 deficiency. The typical presentation
of pernicious anemia includes fatigue, pale appearance, tingling sensation, depression,
alterations to vision and smell, urinary incontinence, psychotic episodes, and weakness.
The most effective treatment for pernicious anemia is intramuscular B12.
Case Report
A 27-year-old woman with a history of vitiligo presented to the emergency department
(ED) with bilateral lower extremity weakness, clumsiness, numbness, and tingling.
Physical examination revealed ataxia, no sensation below her umbilicus, decreased
strength, and hyperreflexia in both lower extremities. Complete blood count in the
ED revealed low hemoglobin and hematocrit and elevated mean corpuscular volume, concerning
for pernicious anemia. Further laboratory testing upon inpatient admission revealed
a low vitamin B12 level and parietal cell antibodies in the blood. The patient's pernicious
anemia was treated with intramuscular vitamin B12 injections, which led to near complete
resolution of her symptoms.
Why Should an Emergency Physician Be Aware of This?
Early suspicion and detection of pernicious anemia in the ED can prevent serious and
permanent hematologic and neurologic damage and the development of other autoimmune
disorders.
Keywords
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Article info
Publication history
Published online: October 28, 2022
Accepted:
October 21,
2022
Received in revised form:
October 6,
2022
Received:
July 7,
2022
Identification
Copyright
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