This anemia is of obscure etiology, characterized by progressive
destructive hemolysis of the erythrocytes, usually with fatal
termination. The cells retain their hemoglobin carrying ability,
so that while the hemoglobin is decreased in percentage, the
proportionately greater decrease in the number of erythrocytes leads
to a marked increase in the color index. The destructive influence
upon the red cells may be sufficient to allow only a small percentage
of the erythrocytes to appear normal and show the greater number to be
deformed, or in various stages of degeneration. Cells which in times
of health would have been sent to the “salvage station” are retained
to carry an over-load for them of hemoglobin to the needy tissues.
Immature nucleated cells of all types are drawn into the battle long
before they can be efficient carriers to help supply oxygen to the
tissues. Seldom will a secondary anemia be severe enough to produce
megaloblasts in the blood stream yet they are a rather constant finding
in pernicious anemia. With these cells of irregular carrying capacity
and development, anisocytosis and polychromatophilia are expected
findings.
=Symptoms.=—The condition must be regarded as a symptom complex or
a result of pathologic process or processes. A type of anemia very
similar in symptoms and blood findings to the pernicious anemia is
produced by the toxins of advanced malignancy, and by at least two
forms of intestinal parasites, the ankylostoma duodenale and the
bothriocephalus latus. In the true pernicious anemia we have similar
results but are not able to locate the primary pathology. There are
present synchronously, enormously increased destruction of erythrocytes
and enormously increased production of them but we are unable to
determine which is primarily at fault. The belief that the cells are
more fragile and too easily broken up has led to the removal of the
erythrocyte destroying spleen in the hope that destruction would be
delayed until regeneration of even imperfect cells would balance the
need. Occasionally, the algebraic sum of regeneration and destruction
may be apparently balanced and not tell the tremendous amount of
pathology both productive and destructive, that the body is going
through.
The first symptoms are of easily produced fatigue of all the body,
brain, muscles, diminished digestive secretion, and dyspnea. As a
result of poor tissue oxygenation, fatty degeneration takes place in
the more active organs as the heart, kidneys and liver. There may be
extensive degeneration of varying areas of the central nervous system.
Some of these areas are due to hemorrhages from the general tendency to
breaking down of vessel walls. Often these areas of destruction affect
the posterior horns of the spinal cord, and, occasionally, a blood
count differentiates between similar symptoms of pernicious anemia and
tabes dorsalis. There is seldom any emaciation; usually the patient
appears “puffy” with a “pasty” color. There is variable subcutaneous
edema. The symptoms being of such wide distribution and character, the
patient is usually treated for all sorts of supposed conditions until
some one makes a blood count at a time when there is enough disturbance
of equilibrium to give the findings of pernicious anemia.
=Treatment.=—The treatment of the form due to intestinal parasites
gives striking results on removal of the causative organisms. Some
advise treating all cases having these blood findings on the assumption
that the presence of these parasites is responsible for the condition.
The treatment of the idiopathic form resolves itself into building
up the ability of the body to resist disease and the removing of all
possible agents for depressing the vitality of the body. Rest in bed
coupled with the digestible and assimilable limit of nutrition often
gives temporary improvement. Removal of questionable teeth also often
aids for a time. Correction of troublesome osteopathic lesions is often
accompanied by the same result. The symptomatic osteopathic treatment
always makes the patient more comfortable, often gives temporary
improvement, and, occasionally, has given a return to normal that has
persisted for several years.
=Prognosis.=—It is nearly always possible to obtain transient
improvement, but the pernicious anemia patient is usually dead within
two years from the time the diagnosis is well established.