Pernicious anaemia

Pernicious anaemia is the end stage of an autoimmune gastritis resulting in destruction of the gastric mucosa, a disorder that can be predicted long before it presents itself clinically.

Only a small proportion (10-15%) of patients with autoimmune gastritis develop pernicious anaemia. Nonetheless, with an estimated prevalence of 1.9% in Western adult populations at or over the age of 60 years, pernicious anaemia represents the commonest cause of vitamin B12 deficiency in these populations.

Although silent until the end stage, the gastric lesion can be predicted years before clinical presentation by immunologic markers specific for gastric autoimmunity. The gastritis results in a deficiency of intrinsic factor, a protein that binds avidly to dietary vitamin B12 and promotes its transport to the terminal ileum for absorption. Consequently, the gastritis is expressed clinically as vitamin B12 deficiency associated with megaloblastic anaemia. The anaemia was indeed pernicious when first discovered, but is now readily controlled by vitamin B12 treatment.