A 35yo lady is admitted with pyrexia, weight loss, diarrhea and her skin is lemon yellow in color.
CBC = high MCV. What is the most probably dx?
a. Aplastic anemia
b. Pernicious anemia
c. Leukemia
d. ITP
e. Lymphoma
answer: B
jaundice, high MCV= pernicious anemia
weight loss, fever, diarrhea could be due to addisons disease
Pathophysiology of Pernicious Anemia
• auto-antibodies produced against gastric parietal cells leading to achlorhydria and lack of
intrinsic factor secretion
• intrinsic factor is required to stabilize B12 as it passes through the bowel
• decreased intrinsic factor leads to decreased ileal absorption of B12
• may be associated with other autoimmune disorders (polyglandular endocrine insufficiency)
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