Clinical features are those of vitamin B12 deficiency. However in pernicious anaemia there is an insidious onset and so there may be a profound degree of anaemia at the time of diagnosis.

Possible clinical features of pernicious anaemia include (1,2,3)

• general features include: (premature greying of the hair)
  • tiredness/lethargy
  • dry skin
  • brittle nails
  • glossitis - beefy red tongue
  • alopecia or greying
  • low grade pyrexia
  • weight loss
  • reduced appetite
  • lemon yellow colour:
    • jaundice, due to haemolysis
    • pallor, due to anaemia
      
      
• neurological features include:
  
  
  • dementia/memory loss/poor concentration
  • peripheral neuropathy, subacute combined degeneration of the cord - paraesthesia, numbness, difficulty in walking, weakness
• cardiorespiratory features
  • palpitations, shortness of breath
    
    
• gastrointestinal features include:
  • anorexia, weight loss
  • diarrhoea, altered bowel habit, malabsorption
  • taste disturbance
    
    
• psychological/psychiatric features include:
  • depression
  • irritability
  • emotional lability
    
    
• ophthalmalogical features include:
  • retrobulbar neuritis - poor vision
  • optic atrophy - blindness
    

Notes:

• incidence of low-grade fever in nutritional megaloblastic anemia varies from 28% to 60% (3)

Reference:

• Mohamed M et al. Pernicious anaemia. BMJ 2020;369:m1319.
• Pulse 2004; 64(35):88.
• Tahlan A et al. Spectrum and analysis of bone marrow findings in anemic cases. Indian J Med Sci. 2008;62:336-9