What are the goals of treatment for pernicious anemia?

Updated: Feb 18, 2019
  • Author: Srikanth Nagalla, MD, MS, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The following goals are the most important in establishing care for patients with pernicious anemia:

  • To establish that the patient has cobalamin deficiency

  • If there is evidence for folic acid deficiency but pernicious anemia has not been ruled out, treat with both folic acid and cobalamin until pernicious anemia has been ruled out. The reason is that folic acid restores blood counts but does not prevent the development of subacute combined system degeneration in patients with pernicious anemia.

  • To determine the cause of the failure to absorb cobalamin (This goal is somewhat controversial. Not all hematologists work to establish the precise cause of low vitamin B12 levels. The nuclear medicine tests are expensive and cumbersome, and as a result, many hematologists simply proceed to treatment once a differential diagnosis of a low vitamin B12 state is established.)

  • To treat the patient with adequate doses of cobalamin

  • To confirm the diagnosis by documenting that specific therapy is effective

  • To ensure administration of adequate quantities of cobalamin for the lifespan of the patient


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