Pernicious anaemia: a study of one hundred and seventy cases with special reference to complications

Abstract

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.