A resume of recent literature dealing with the
complications of pernicious anaemia is given.
Tables have been compiled showing the sex, age,
haemoglobin percentage when first and last seen, complications
and treatment in 170 cases. Of these, males
numbered 84 and females 86. The average age on admission
was males 49, females 46.
Notes of cases of special interest are included.
The incidence and significance of complications is
discussed.
Postero-lateral degeneration in some degree occurred
in 28 per cent of cases and to an advanced degree
in 13 per cent.
Notes on duration, mortality and treatment are
given.
The question is raised whether the red marrow in
the shafts of the long bones and the iron deposits in
the liver revert to normal during remissions. (Case 6).
Attention is called to the occurrence of glossitis
occurring during remission of the anaemia. (Case 114).
Three cases showed fibrillar tremors and muscular
wasting in addition to symptoms of postero-lateral
degeneration.
Among the points of interest that emerge from this
study are the following.
1. Since the introduction of liver therapy pregnancy
in cases of pernicious anaemia is no longer rare.
It occurred in 4 of the 86 female cases.
While pernicious anaemia is a serious complication
of pregnancy, pregnancy is not a serious complication
of well-treated pernicious anaemia.
2. Cases of pernicious anaemia now live to have
numerous complications. Forty different conditions
were associated with the 170 cases studied, and some
complication was present in 70 per cent of the cases.
The most common and debilitating is postero-lateral
degeneration.
3. The great majority of the associated conditions are
fortuitous but some of these, notably arteri.oscler.
osis, are important on account of their frequency,
and effect on expectation of life.
4. Expectation of life has greatly increased:- Thus,
(a) Of the 170 cases seen in the course of ten
years 55 are still under observation and 10
are dead, but nothing is known of the others -
many had come from a distance.
(b) Of the 170 cases admitted to hospital only 10
are known to have died and only one of these of
uncomplicated pernicious anaemia.
(c) It is probable that many cases die of vascular
or nervous complications or may be killed by
motor cars.
(d) It would appear that pernicious anaemia, so long
as well treated, is not now a very fatal disease.
It is the complications that kill, and among the
most serious of these is old age.
