clinical features

Last edited 04/2020

Clinical features are those of vitamin B12 deficiency. However in pernicious anaemia there is an insidious onset and so there may be a profound degree of anaemia at the time of diagnosis.

Possible clinical features of pernicious anaemia include (1,2,3)

  • general features include:
    • tiredness/lethargy
    • dry skin
    • brittle nails
    • glossitis - beefy red tongue
    • alopecia or greying
    • (premature greying of the hair)
    • low grade pyrexia
    • weight loss
    • reduced appetite
    • lemon yellow colour:
      • jaundice, due to haemolysis
      • pallor, due to anaemia

  • neurological features include:
    • dementia/memory loss/poor concentration
    • peripheral neuropathy, subacute combined degeneration of the cord - paraesthesia, numbness, difficulty in walking, weakness

  • cardiorespiratory features
  • include:
    • palpitations, shortness of breath

  • gastrointestinal features include:
    • anorexia, weight loss
    • diarrhoea, altered bowel habit, malabsorption
    • taste disturbance

  • psychological/psychiatric features include:
    • depression
    • irritability
    • emotional lability

  • ophthalmalogical features include:
    • retrobulbar neuritis - poor vision
    • optic atrophy - blindness


  • incidence of low-grade fever in nutritional megaloblastic anemia varies from 28% to 60% (3)
  • - however attributing a low grade fever to this scenario requires exclusion of infective and inflammatory causes of fever