[Applause] [Music] hi this is tom from zero2finals.com in this video i'm going to be going through pernicious anemia and you can find written notes on this topic at xerodefinals.com pernicious anemia or in the hematology section of the zero to finals medicine book let's jump straight in pernicious anemia is a cause of vitamin b12 deficiency anemia and b12 deficiency can be caused by either insufficient dietary intake of vitamin b12 or pernicious anemia let's start with the pathophysiology the parietal cells in the stomach produce a protein called intrinsic factor and intrinsic factor is essential for the absorption of vitamin b12 in the ileum pernicious anemia is an autoimmune condition where antibodies form against the parietal cells or intrinsic factor a lack of intrinsic factor prevents the absorption of vitamin b12 and the patient becomes vitamin b12 deficient vitamin b12 deficiency can cause a number of neurological symptoms and these are peripheral neuropathy with numbness or paresthesia and paracesaries like pins and needles a loss of vibration sense or a loss of proprioception visual changes and then mood and cognitive changes a quick tom tip for your exams remember testing for vitamin b12 deficiency and pernicious anemia and patients presenting with peripheral neuropathy particularly with pins and needles so there's two antibodies and testing for auto antibodies is used to diagnose pernicious anemia the first is intrinsic factor antibodies which is the first line investigation and the second one is gastric parietal cell antibody which can also be tested but tends to be less helpful so what's the management well dietary deficiency can be treated with oral replacement with cyanocobalamin unless the deficiency is severe but in pernicious anemia oral replacement is inadequate because the problem is absorption rather than intake they can be treated with one milligram of intramuscular hydroxycobalamin three times weekly for two weeks then every three months and more intense regimes are used where there's neurological symptoms for example one milligram every other day until the symptoms improve if there's also folate deficiency it's important to treat the b12 deficiency first before you correct the folate deficiency treating patients with folic acid when they have a b12 deficiency can lead to subacute combined degeneration of the cord and quite significant neurological problems thank you for watching this video if you liked the video left a comment or subscribe to the channel thank you so much it really helps zero to finals is not just a youtube channel there's also a website with detailed notes illustrations and questions an instagram account where new questions are posted every day to help you test your knowledge books flash cards and much more i also have a personal channel where i share my thoughts and tips on learning medicine and you can find links to everything in the description of this video see you next time