Pernicious anemia

Introduction Pernicious anemia, also known as megaloblastic anemia, is rare in China. The cause is often caused by pregnancy, lactation, malabsorption of the stomach, malnutrition or oral folic acid antagonists (which antagonize dihydrofolate synthetase and cause obstacles in the synthesis of tetrahydrofolate). Drugs, such as acetaminophen, methotrexate.

Cause

Benign anemia is different from malignant anemia. The former is due to iron deficiency, which reduces hemoglobin (hemoglobin) synthesis, but red blood cells are not low. The latter is a lack of hematopoietic factors such as folic acid and vitamin B12, which makes the formation of deoxyribonucleic acid (DNA) in the development of immature red blood cells, hindering the division of cells, forming malformed giant red blood cells, accompanied by neurological symptoms (neuritis, Nerve atrophy).

an examination

Related inspection

Blood routine bone marrow bacterial culture

1. Blood routine examination for the severity of anemia and anemia, with changes in the number of white blood cells or platelets. According to the red blood cell parameters (MCV, MCH and MCHC), the red blood cell morphology can be classified into anemia, which provides relevant clues for diagnosis. Reticulocyte counts indirectly reflect bone marrow erythroid hyperplasia and compensatory conditions. Peripheral blood smears can observe changes in the number or morphology of red blood cells, white blood cells, platelets, and whether there are malaria parasites and abnormal cells.

2. Bone marrow examination Bone marrow cell smears reflect the proliferation, cell composition, proportion and morphological changes of bone marrow cells. Bone marrow biopsy reflects changes in the structure, proliferation, cellular composition and morphology of bone marrow hematopoietic tissue. Bone marrow examination has diagnostic value for certain anemia, leukemia, bone marrow necrosis, myelofibrosis or marble, and extramedullary tumor cell infiltration. Attention must be paid to the limitations of bone marrow sampling. When there is a contradiction between bone marrow examination and blood routine, multiple bone marrow examinations should be performed.

3. The pathogenesis of anemia is examined such as iron metabolism of iron deficiency anemia and primary disease examination for iron deficiency, serum folic acid and vitamin B12 levels of megaloblastic anemia, and primary disease examination leading to the lack of such hematopoietic materials. Primary disease examination of hemorrhagic anemia, hemolytic anemia can occur increased free hemoglobin, decreased haptoglobin, increased potassium, indirect bilirubin increased. Sometimes it is necessary to perform tests such as erythrocyte membrane, enzyme, globin, heme, autoantibody, alloantibody or PNH clone, chromosome, antigen expression, cell cycle, gene examination of bone marrow hematopoietic cells, and T cell subsets and Secreted factors or bone marrow cells autoantibodies, etc.

Comprehensive analysis of the history, physical examination and laboratory results of anemia patients can determine the etiology or pathogenesis of anemia, thereby making anemia diagnosis.

Differential diagnosis

First of all, it should be differentiated from red blood disease, the latter is ineffective with vitamin B12 treatment, and the morphology of immature red blood cells has obvious pathological changes. In the recurrent period, there is often hemolysis, which should be distinguished from other types of hemolytic anemia. The patient has loss of appetite, lack of free hydrochloric acid in the stomach, and needs to be distinguished from gastric cancer; however, it should be noted that this disease can be the early stage of gastric cancer.

1 megaloblastic anemia.

2 glossitis and lack of stomach acid.

3 peripheral nerve degeneration and spinal cord combined degeneration. Symptoms of the nervous system include: peripheral numbness caused by numbness or paresthesia of the limbs, post-cortical degeneration of the spinal cord caused by the disappearance of tendon reflexes, decreased muscle tone, disordered position, hyperreflexia and increased muscle tone. Neurological symptoms can be prominent in the disease, and even the patient is suspected of peripheral neuritis or multiple sclerosis and first visits to the neurology department.

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