Clinical Picture of Pernicious Anaemia Prior to Introduction of Liver Therapy in 1926 and in Edinburgh Subsequent to 1944

Vitamin B12 and folic acid deficiency presenting as acute febrile illness: a case report

“…Another proposed mechanism is that megaloblastic anaemia leads to hyperplasia and thus increased activity within the bone marrow leading to systemic pyrexia. 5,10 The level of pyrexia usually correlates with degree of anaemia and subsides within three days after adequate vitamin supplementation, 7,11 this is concordant with our case and this is felt to be due to immediate improvement in ineffective erythropoiesis. 5 Patients presenting with fever, anaemia, neutropenia and thrombocytopenia (pancytopenia) are usually treated on the lines of febrile neutropenia with broad spectrum antibiotics and empirical antimalarials, which if caused by megaloblastic anaemia leads to unnecessary antibiotic/ antimalarials use and investigations specially in resource poor settings .…”

“…[6][7][8][9] Usually this is low grade fever and occasionally high grade fever can be seen in those patients with severe anemia. [10][11] Pyrexia is a feature of megaloblastic anaemia that has been described previously in the literature. 5,8,11,12 The exact cause of pyrexia in megaloblastic anaemia is not known and probably it may reflect a defect in oxygenation to the thermo-regulatory centres in the brain 11 However, this theory fails to explain why the fever seen in patients with megaloblastic anaemia is not a recognised feature of other forms of anaemia.…”

An interesting case of fever, pancytopenia and hyperpigmentation

“…One opinion put forth attributes this due a thermoregulatory defect of the brain due to poor oxygenation of thermoregulatory area of the brain. [6,8] However the postulation fail to explain the conspicuous absence of fever in other forms of anemia. Megoblastic anemia is a result of an over productive but ineffective functioning marrow.…”

Pernicious Anæmia

“…Diagnosis of Pernicious An:emia Davidson (1957) has given a comprehensive account of the clinical findings in this disease, none of which is pathognomonic. The most frequently occurring symptoms of pernicious anemia are tiredness and lassitude, soreness of the tongue and panesthesia.…”

“…A case can be made for performing all the commoner tests of the state and activity of the gastric mucosa, such as: acid secretion; pepsin production; plasma pepsinogen concentration or uropepsinogen excretion; intrinsic-factor activity of the gastric juice; gastric biopsy; and a battery of tests of absorption by the small gut, of which absorption of fat by the fat balance and '31iodinelabelled triolein techniques, of xylose and of radioactive iron are the most widely used. In practice, in the absence of diarrhcea, which occurs in about 95% of all cases of malabsorption syndrome (Bossak, Wang and Adlersberg, 1957) and in less than io% of patients with pernicious anaemia (Davidson, 1957), the most useful single test is of acid production in response to an effective dose of a powerful stimulant of the gastric parietal cells. Whereas demonstrable acid secretion is absent or markedly impaired in pernicious anaemia (except in the rare juvenile type), in the malabsorption syndrome gastric secretion of acid is normal or moderately impaired and only rarely falls within the range found in pernicious anemia.…”