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 DCI Home: Blood Diseases: Pernicious Anemia: Diagnosis

      Pernicious Anemia
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How Is Pernicious Anemia Diagnosed?

Pernicious anemia is diagnosed using a person’s medical history, physical exam, and tests that can determine the type and cause of anemia. A doctor can use these methods to find out how severe the problem is, its cause, and the appropriate treatment. Mild to moderate anemia may have no signs or symptoms. In fact, anemia is often discovered unexpectedly on screening tests.

Specialists Involved

Primary care doctors, such as a family doctor, often diagnose and treat pernicious anemia. Other kinds of doctors may also be involved, including:

  • A neurologist (nervous system specialist)
  • A cardiologist (heart specialist)
  • A hematologist (blood disease specialist)
  • A gastroenterologist (digestive tract disease specialist)

Medical and Family History

Your doctor may ask detailed questions about many symptoms, including feeling tired and weak and others listed in the section What Are the Signs and Symptoms of Pernicious Anemia? The doctor may ask about any personal or family history of anemia, diabetes, or diseases of the immune system. You may be asked about any surgery you have had, especially stomach surgery. The doctor may also ask you about your diet and about the medicines you are taking.

Physical Exam

A physical exam may include:

  • Checking for pale or yellowish skin and a red, smooth tongue
  • Listening to the heart to check for a rapid heartbeat or murmur
  • Feeling the abdomen to check the size of the liver

Your doctor will also order a number of tests or procedures to be sure about the type of anemia you have and how severe it is.

Diagnostic Tests and Procedures

Complete Blood Count

Usually, the first test used to diagnose anemia is a complete blood count (CBC). The CBC tells a number of things about a person’s blood, including:

  • The hemoglobin level. Hemoglobin is the iron-rich protein in red blood cells that carries oxygen through the body. A low hemoglobin level means a person has anemia.
  • The hematocrit (hee-MAT-oh-crit) level. The hematocrit level measures how much of the blood is made up of red blood cells. Low hematocrit is another sign of anemia.

The CBC also checks:

  • The number of red blood cells. Too few red blood cells means a person has anemia. A low number of red blood cells is usually seen with either a low hemoglobin or a low hematocrit level, or both.
  • The number of white blood cells. White blood cells are involved in fighting infection.
  • The number of platelets in the blood. Platelets are small cells that are involved in blood clotting.
  • Red blood cell size. The mean cell volume is the name of a test that measures the average size (volume) of red blood cells. In pernicious anemia, the red blood cells are usually larger than normal. This is called macrocytosis (MAK-ro-si-TO-sis).

Tests To Check the Vitamin B12 Level

  • Vitamin B12. The level of vitamin B12 in the bloodstream may be normal or borderline even when the total amount of B12 in the body is low.
  • Folic acid (folate). This is another B vitamin that can be low when the B12 level is low. A lack of folic acid can also cause anemia.
  • Homocysteine. Homocysteine is high in anemia due to the lack of vitamin B12 or folic acid. Folate deficiency is more common because this vitamin is used up more quickly and the dietary need is greater. In this case, the blood’s B12 level can be normal.
  • Methylmalonic (METH-il-ma-LON-ik) acid. The level of methylmalonic acid is high in anemia due to a lack of vitamin B12 or folic acid. Methylmalonic acid can also be checked with a urine test.

Other Blood Tests

Other blood tests check for:

  • The presence of intrinsic factor antibodies and parietal cell antibodies. These antibodies in the blood may mean that they are destroying the intrinsic factor or parietal cells.
  • Levels of bilirubin, potassium, or cholesterol in the blood.
  • Serum iron and iron binding capacity.
  • The number of reticulocytes (re-TIK-u-lo-sites). Reticulocytes are young, red blood cells. The reticulocyte test is used to see if the bone marrow is producing red blood cells at the proper rate. A lower than average number of reticulocytes can mean that the bone marrow is not making enough red blood cells. The reticulocyte number is low in people with pernicious anemia.

Schilling Test

The Schilling test is a urine test that measures how well the body absorbs vitamin B12. It is not used as much now as it was in the past.

Bone Marrow Tests

In some cases, a doctor may want to do a bone marrow biopsy or aspiration. A bone marrow biopsy is a minor surgical procedure to remove a small amount of bone marrow tissue. In a bone marrow aspiration, the doctor removes a small amount of bone marrow fluid through a needle. Bone marrow biopsy or aspiration tests whether the bone marrow is healthy and can show whether the bone marrow is making enough blood cells.


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