Paresthesias and Anemia
In the latest , a 62-year-old man was admitted to this hospital because of paresthesias, weight loss, jaundice, and anemia.
Paresthesias involve a sensation of tingling, numbness, crawling, orÂ deadness, and they are felt mainly in distal parts of theÂ extremities.
Although they very rarely involve the thalamus,Â paresthesias are mostly considered to be related to a spinal cordÂ disorder that probably results from ectopic discharge in damagedÂ dorsal-column axons and may be present before any other abnormalitiesÂ are detectable on neurologic examination.
The combination of paresthesias and sensory ataxic gait is typicallyÂ caused by dysfunction of the dorsal columns, and may be caused byÂ syphilis, tickborne illnesses, human immunodeficiency virusÂ infection, vitamin deficiencies including deficiencies of vitaminÂ B12, folate and vitamin E, and systemic inflammatory conditions suchÂ as neoplasia, paraneoplastic syndromes, and autoimmune diseases.Â Although they are less likely, multiple sclerosis and amyloidosisÂ should also be considered as well.
The different causes of macrocytic anemia can be classified asÂ arising from immature or stress cells (e.g., reticulocytosis,Â aplasias, and Fanconi’s anemia), abnormal DNA metabolism (e.g.,Â vitamin B12 and folate deficiency and drugs or toxins), abnormalÂ lipid metabolism (e.g., liver disease and hypothyroidism), a boneÂ marrow disorder (e.g., myelodysplastic syndromes, leukemia, andÂ congenital abnormalities), and an unknown mechanism (e.g., alcoholismÂ and plasma-cell dyscrasias).
A: The classic triad of clinical findings associated with vitamin B12Â deficiency is weakness and fatigue, glossitis, and paresthesias.
InÂ addition, other clinical findings include anemia, clumsiness andÂ unsteady gait, nonspecific gastrointestinal symptoms, and weight loss.
A: Classic findings associated with pernicious anemia include atrophicÂ body gastritis and intrinsic factor deficiency.
A highly elevatedÂ fasting gastrin level (504 pg per milliliter; reference range, <100Â pg per milliliter) and a reduced pepsinogen I level (<24.6 ng perÂ milliliter; reference range, 28 to 100 ng per milliliter) areÂ consistent with atrophic body gastritis.
The detection of antibodiesÂ to intrinsic factor is useful in making the diagnosis of perniciousÂ anemia.
In approximately 40 to 60% of patients with perniciousÂ anemia, positivity for anti-intrinsic factor antibodies is presentÂ and provides evidence to support the diagnosis, with a specificityÂ approaching 100%.