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Medicine

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Hematology

Question
9 out of 16
 

Which of the following is true about CNS feature in pernicious anemia?



A Planter are upgoing & DT are usually not brisk

B Reversibal dementia

C Optic atrophy

D All of the above

Ans. D

All of the above

Clinical Features

Pernicious anaemia or Addison’s anaemia (Do not get confuse with Addison’s disease)

1. It is commonly associated with other autoimmune disorder including thyroid disease (thyrotoxicosis, myxedema, Hashimoto disease), vitiligo, hypoparathyroidism, premature graying, blue eye, blood group A & HLA-3.

2. Life expectancy is normal in female

Decrease in male (because of increased incidence of carcinoma stomach – 3 times more as compared to normal person)

3. Biochemical analysis

a. HCI secretion b. Pepsin secretion

c. Intrinsic factor secretion d. S. gastrin

4. Gastric biopsy – shows atrophy of all layers of body and fundus, absence of parietal and chief cells.

5. Types of serum antibody.

a. Blocking/type I antibody – Prevent combination of Intrinsic Factor and cobalamin – 55%

b. Binding type II antibody – prevent attachment of Intrinsic Factor to ileal mucosa – 35%

6. Parietal cell antibody present in 90% of patients.

Pallor (lemon Colour), smooth tongue, cardiac “ hemic” systolic murmur, hepatomegaly, rarely splenomegaly. Neurologic picture in vitamin B12 deficiency ranges from mental inattentiveness to severe mental confusion with or without dorsal and lateral column signs (subacute combined degeneration).

These signs are reversible with cobalamin therapy.

Tongue in Vit B12 deficiency

1. Macroglossia

2. Atrophic glossitis (smooth tongue due to Loss of papillae)

3. Moeller’s glossitis (A superficial form of glossitis marked by irregular red patches on the tongue and sensitivity to hot or spicy food)

4. Sore Tongue (Red and inflamed)

5. Beefy tongue

Table: Neurological Findings in B12 Deficiency

1. Peripheral nerves - Glove and stocking paraesthesia

2. Spinal cord

a. Subacute combined degeneration

b. Posterior columns – diminished vibration and proprioception

c. Corticospinal tracts – upper motor neuron signs

3. Cerebrum - Dementia (reversible dementia) AIPG 2007

4. Cranial nerve- Optic atrophy

5. Autonomic neuropathy

Extra Edge: In B12 deficiency, despite involvement of corticospinal tract, DTR are not brisk but planter is up going. (PGI Dec 2008) (Normal DTR with positive Babinski sign)

Hematology Flashcard List

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