Pernicious anemia is a true deficiency disease for which specific replacement therapy is available. In idiopathic pernicious anemia the deficiency once present continues throughout the life of the patient. The disease is never “cured.” The deficiency responsible for the symptoms is satisfied, however, by complete and continued treatment. A symptomatic deficiency in the specific factor may occur temporarily, as in pregnancy where the need is for a time greater than the supply, or when absorption is interfered with as in sprue or other abnormality of the small intestine. Here the deficiency disappears with the relief of the underlying causative disease, although specific therapy is usually helpful.
The seriousness of idiopathic pernicious anemia is best emphasized by the fact that it was always fatal before the introduction of liver treatment by Minot and Murphy in 1926 and is still fatal without specific therapy. While anemia is always present and is usually the early symptom, neurologic involvement occurs almost always in time in untreated cases and usually in patients not completely treated. Subacute combined sclerosis of the spinal cord may lead to a crippling and permanent disability. A disease which is always fatal if untreated and often leads to serious permanent disability if insufficiently treated merits serious attention.
The first consideration is a correct diagnosis. If it is definitely determined that the patient has idiopathic pernicious anemia, treatment is necessary throughout life. All too often a patient is given liver extract for an anemia which has not been properly studied, and a. . .