Gastro: Pernicious Anaemia: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Pernicious Anaemia: Autoimmune B12 Deficiency Explained🎧 High-yield revision of this autoimmune cause of B12 deficiency – crucial for MSRA prep and daily practice.🧠 Key Learning Points📌 Definition• Pernicious Anaemia (PA) = autoimmune B12 deficiency due to intrinsic factor (IF) loss• Caused by destruction of gastric parietal cells (which make IF and acid)📌 Causes & Risk Factors• Autoimmune gastritis (most common)• Gastric surgery, chronic H. pylori• Associated autoimmune diseases (TAD RAVE mnemonic):– Thyroid, Addison’s, Diabetes T1, RA, Vitiligo• Women >40, Northern European, blood group A📌 Mnemonics• TAD RAVE – Autoimmune links• F FACTORS – Folate deficiency causes (Food, Foetus, Failure, Folate antagonists)📌 Pathophysiology• Autoantibodies:– Block IF or destroy parietal cells• Leads to B12 deficiency →– Megaloblastic anaemia– Neurological damage (myelopathy, neuropathy)📌 Clinical Features• Anaemia: fatigue, pallor, SOB• Neuro: tingling, peripheral neuropathy, ataxia, memory loss• Subacute combined degeneration of spinal cord• Glossitis, lemon-tinged skin, mouth ulcers📌 Investigations• FBC: macrocytic anaemia (↑MCV)• Blood film: hypersegmented neutrophils• ↓ B12 (<200 ng/L)• Antibodies:– Anti-intrinsic factor (specific)– Anti-parietal cell (sensitive)• Check folate too• Consider MMA/homocysteine if B12 borderline• Gastroscopy if iron deficiency (gastric cancer risk)📌 Diagnosis Tips✅ Anti-IF Ab + low B12 = confirmed PA✅ Always check folate + B12 together🚫 Never give folate alone if B12 uncertain – masks anaemia, worsens neuro signs📌 Management• Hydroxocobalamin IM (lifelong):– No neuro signs: 1mg IM 3x/week for 2w → 1mg every 3m– With neuro signs: 1mg alt days → then every 2m• Folate if B12 normal or replaced• Rarely: oral B12 in maintenance• Monitor response: FBC, symptoms📌 When to Refer• Haematology: neuro symptoms, pregnancy, unclear diagnosis, malignancy• Gastro: suspected malabsorption, concern for gastric cancer📌 Prognosis & Complications• Excellent with regular B12 treatment• Reversible neuro signs if early• If untreated:– Irreversible neuropathy– Subacute combined degeneration– Infertility– Gastric cancer risk– Heart failure– Psychiatric and cognitive issues📌 Epidemiology• UK prevalence: 0.1–1%• Women 40–70 years most affected• More common in Northern Europeans• B12 deficiency more common than PA• Up to 20% of over-60s may have low B12 📎 More MSRA Resources for Pernicious Anaemia📝 Revision Notes:https://www.passthemsra.com/topic/pernicious-anaemia-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/pernicious-anaemia-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/pernicious-anaemia-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/pernicious-anaemia-rapid-quiz/🎓 Full Course:https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA#MSRARevisionNotes #PerniciousAnaemia #MSRAFlashcards #B12Deficiency#MacrocyticAnaemia #NeuroComplications #IntrinsicFactor #AutoimmuneDisorder#GastroMSRA #MSRAExam #MSRARevisionWebsite