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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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


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


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